Chapter 1. Getting started as a member SECTION 1 Introduction 6 Section 1.1 You are enrolled in Provider Partners Pennsylvania Advantage (HMO SNP), which is a Medicare HMO Error! Bookmark not defined. Section 1.1 You are currently enrolled in Provider Partners Pennsylvania Advantage (HMO SNP), which is a specialized Medicare Advantage Plan (“Special 6 Needs Plan”) Section 1.2 What is the booklet about? 6 Evidence of Coverage Section 1.3 Legal information about the 7 Evidence of Coverage SECTION 2 What makes you eligible to be a plan member? 7 Section 2.1 Your eligibility requirements 7 Section 2.2 What are Medicare Part A and Medicare Part B? 8 Section 2.3 Here is the plan service area for Provider Partners Pennsylvania Advantage (HMO SNP) 8 Section 2.4 U.S. Citizen or Lawful Presence 9 SECTION 3 What other materials will you get from us? 9 Section 3.1 Your plan membership card Use it to get all covered care and – prescription drugs 9 Section 3.2 The Your guide to all providers in the network . 10 Provider Directory: plan’s Section 3.3 The Your guide to pharmacies in our network 10 Pharmacy Directory: Section 3.4 The List of Covered Drugs 11 (Formulary) plan’s Section 3.5 The (the D with a Part D Explanation of Benefits “Part EOB”): Reports summary of payments made for your Part D prescription drugs 11 SECTION 4 Your monthly premium for Provider Partners Pennsylvania Advantage (HMO SNP) 11 Section 4.1 How much is your plan premium? 11 SECTION 5 Do you have to pay the Part D enrollment 12 “late penalty”? Section 5.1 What is the Part D enrollment 12 “late penalty”? Section 5.2 How much is the Part D late enrollment penalty? 13 Section 5.3 In some situations, you can enroll late and not have to pay the penalty 14 Section 5.4 What can you do if you disagree about your Part D late enrollment penalty? 14 SECTION 6 Do you have to pay an extra Part D amount because of your income? 15 Section 6.1 Who pays an extra Part D amount because of income? 15
Chapter 1. Getting started as a member SECTION 1 Introduction 6 Section 1.1 You are enrolled in Provider Partners Pennsylvania Advantage (HMO SNP), which is a Medicare HMO Error! Bookmark not defined. Section 1.1 You are currently enrolled in Provider Partners Pennsylvania Advantage (HMO SNP), which is a specialized Medicare Advantage Plan (“Special Needs Plan”) 6 Section 1.2 What is the Evidence of Coverage booklet about? 6 Section 1.3 Legal information about the Evidence of Coverage 7 SECTION 2 What makes you eligible to be a plan member? 7 Section 2.1 Your eligibility requirements 7 Section 2.2 What are Medicare Part A and Medicare Part B? 8 Section 2.3 Here is the plan service area for Provider Partners Pennsylvania Advantage (HMO SNP) 8 Section 2.4 U.S. Citizen or Lawful Presence 9 SECTION 3 What other materials will you get from us? 9 Section 3.1 Your plan membership card – Use it to get all covered care and prescription drugs 9 Section 3.2 The Provider Directory: Your guide to all providers in the plan’s network 10 Section 3.3 The Pharmacy Directory: Your guide to pharmacies in our network 10 Section 3.4 The plan’s List of Covered Drugs (Formulary) 11 Section 3.5 The Part D Explanation of Benefits (the “Part D EOB”): Reports with a summary of payments made for your Part D prescription drugs 11 SECTION 4 Your monthly premium for Provider Partners Pennsylvania Advantage (HMO SNP) 11 Section 4.1 How much is your plan premium? 11 SECTION 5 Do you have to pay the Part D “late enrollment penalty”? 12 Section 5.1 What is the Part D “late enrollment penalty”? 12 Section 5.2 How much is the Part D late enrollment penalty? 13 Section 5.3 In some situations, you can enroll late and not have to pay the penalty 14 Section 5.4 What can you do if you disagree about your Part D late enrollment penalty? 14 SECTION 6 Do you have to pay an extra Part D amount because of your income? 15 Section 6.1 Who pays an extra Part D amount because of income? 15 .
H4093_ISNP_HMO_NONPOS_Model_wRx_v2-PA_EOC.docx