Medicare Advantage Employer Group Benefits (2014)

These plans are available for business to offer their Medicare-eligible employees and retirees. The Summary of Benefits, Evidence of Coverage, and other information below explain the details about each plan.

Service area: You must live in Brevard County or Indian River County in Florida to enroll in these plans.


Benefits

Summary of Benefits — These booklets explain general information about the plans we have for employer groups and compares them to original Medicare. They also include information about premiums, cost sharing, out-of-network coverage, any limitations, and more.

 Group POS/Plus A/Plus B Summary of Benefits 

Annual Notice of Change —These documents explain the changes that happened from last year to this year:

 Group POS Annual Notice of Change

 Group Plus A Annual Notice of Change

 Group Plus B Annual Notice of Change

Evidence of Coverage —These documents contain the most detailed information about the Group plans:

 Group POS Evidence of Coverage

 Group Plus A Evidence of Coverage 

 Group Plus B Evidence of Coverage


Prescription drug information

Formulary and pharmacies

 Comprehensive formulary — a complete list of covered drugs

Forms

Mail order prescriptions from Health First Family Pharmacy

Mail order prescriptions from MedVantx

Prescription reimbursement form

Requirements

 Prior authorization requirements 

Step Therapy

Transition policy 

Medication therapy management

Utilization Management 

Extra help for prescription drug costs

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your 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. You may be able to get Extra Help to pay for your prescription drug premiums 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/7days 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.

Assistance with Best Available Evidence for Low Income Subsidy


Provider/pharmacy directories

Search for physicians

 Printable provider (physician/pharmacy) directory  — includes information about authorizations, our network of doctors, ancillary services like labs, fitness centers, etc., and also pharmacies

Your privacy, rights, and procedures for grievances, appeals, exceptions

Part D prescription drug prior authorizations, exceptions, appeals and grievances

Medical prior authorizations, appeals, and grievances

 Notice of privacy practices

Please refer to your Evidence of Coverage (EOC) for more details about these topics, as well as your rights and responsibilities upon disenrollment:

 Group POS Evidence of Coverage

 Group Plus A Evidence of Coverage 

 Group Plus B Evidence of Coverage

For more information about our quality assurance policies and procedures or to obtain an aggregate number of the our grievances, appeals, and exceptions, contact customer service.


How to enroll

If your employer (or former employer) offers Health First Health Plans as part of their employee or retiree benefits, check with them for details on how and when to enroll. They may prefer you send your completed enrollment form (and premium payment if necessary) to them. If they ask you to contact us directly to enroll, please follow these instructions.

  2014 Enrollment form


Y0089_MP3798 CMS Approved 03242014
Last updated: 02/13/2014