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PUP (HMO) Medicare Advantage plans are offered by Physicians United Plan (PUP), a health plan with a Medicare contract. Individuals must have both Medicare Part A and B to enroll, and must reside in the service area of the plan. Individuals with End-Stage Renal Disease are generally not eligible to enroll. PUP’s contract with the Centers for Medicare & Medicaid Services is renewed annually. Availability of coverage beyond the end of the current contract year is not guaranteed.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.
For 2011 benefits: Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2012.
Limitations, copayments, and restrictions may apply.
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
You must receive all routine care from plan providers except under emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of network providers neither Medicare nor PUP will be responsible for the costs.
You must use network pharmacies to access prescription drug benefits, except under non-routine circumstances when you cannot reasonably use network pharmacies. Quantity limitations and restrictions may apply.
You may be able to get extra help to pay for your prescription drug premium and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call-1-800-325-0778; or your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
To join PUP Extra (HMO), a Special Needs Plan, you must have Medicare and also receive assistance from the state. Please speak with a benefit consultant or call PUP to see if you are eligible to join. Co-pays, co-insurance and deductibles may vary based on the level of help received. For more information contact PUP at 1-866-571-0693, TTY/TDD 1-800-955-8771 Monday through Sunday, 8:00 a.m. to 8:00 p.m.
Members may enroll in the plan only during specific times of the year. Contact PUP for more information.
Medicare beneficiaries may enroll in PUP through the CMS Online Enrollment Center, located at www.medicare.gov/pdp-enrollment.asp. For more information contact PUP at 1-866-571-0693, TTY/TDD 1-800-955-8771.
This document is available in alternate formats or languages. For more information contact PUP at 1-866-571-0693, TTY/TDD 1-800-955-8771 Monday through Sunday, 8:00 a.m. to 8:00 p.m.
Este documento esta disponible en otros formatos. Para mas informacion, llame a PUP al 1-866-571-0693, TTY/TDD 1-800-955-8771 de Lunes a Domingo, 8:00 a.m. a 8:00 p.m.