처방약 플랜 기본 사항

면책 조항

‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

WellCare는 Centene Corporation의 Medicare 브랜드로, Medicare와 계약을 맺은 HMO, PPO, PFFS, PDP 플랜이며 승인된 Part D 제공자입니다. 당사 D-SNP 플랜은 주 Medicaid 프로그램과 계약을 맺고 있습니다. 당사 플랜 등록은 계약 갱신에 따라 결정됩니다.

“Wellcare” is issued by WellCare Prescription Insurance, Inc.

Washington residents: “Wellcare” is issued by Wellcare of Washington, Inc.

Medicare는 매년 5개 별점 등급 시스템을 토대로 플랜을 평가합니다.

네트워크 비소속/비계약 의료 제공자는 응급 상황을 제외하고 플랜 가입자를 치료할 의무가 없습니다. 네트워크 비소속 서비스에 적용되는 비용 분담을 포함한 자세한 정보는 당사 고객 서비스부로 연락하거나 보장 범위 증명서를 참조하십시오.

Louisiana D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please 연락 정보.

Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any benefits above and beyond traditional Medicare benefits are applicable to Wellcare Medicare Advantage only and do not indicate increased Medicaid benefits.

Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

Wellcare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of Georgia, Hawaii, Missouri, and Nebraska. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-866-892-8340 (TTY: 711) for Wellcare No Premium (HMO) in GA or consult the online pharmacy directory at www.wellcare.com/medicare; 1-877-457-7621 (TTY: 711) for Wellcare ‘Ohana No Premium (HMO) and Wellcare ‘Ohana Low Premium Open (PPO) in HI or consult the online pharmacy directory at www.wellcare.com/ohana; 1-833-444-9088 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-800-977-7522 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

Wellcare Dual Liberty (HMO-D-SNP) Plan

Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year.

Your Part B premium is covered by Medicaid.

This plan is available to those who have both Medicare and full Medicaid benefits.

Wellcare uses a formulary.

Please contact Wellcare for details.