Benefits

• Summary of Benefits — Group Plus - This booklet explains general information about the plan we have for employer groups and compares it to original Medicare. It also includes information about premiums, cost sharing, out-of-network coverage, any limitations, and more.

• Evidence of Coverage - Detailed information about the Group Plus plan

Prescription drug information

Health First Health Plans has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. We have 95 network pharmacy locations in our local area, and more than 47,000 nation-wide.

• Formulary - a complete list of the drugs we cover
• Participating pharmacies - listed in the provider directory
• Prescription mail order form
• Order mail order prescriptions online
• How to order mail order prescriptions
• Prescription reimbursement form

• Prior authorizations, exceptions, appeals and grievances
• Transition policy
• Medication therapy management, and drug and/or utilization management

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.

Provider/pharmacy directory

• Search for physicians
• Printable directory - includes information about authorizations, our network, ancillary services (labs, fitness centers, etc.), and pharmacies

How to enroll

If your employer (or former employer) offers Health First Medicare 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 contact us directly to enroll, you can mail us your form, drop it off at our office, or we can pick it up from you. Our address is:

Health First Health Plans
6450 US Highway 1
Rockledge, FL 32955

To be eligible to enroll, be entitled to Medicare Part A and enrolled in Part B, and continue to pay your Part B premium if not otherwise paid for under Medicaid or by another third party, and live in our service area. Once we verify your eligibility with Medicare, your coverage will become effective the first day of the month after we receive your enrollment form.

Health First Health Plans is a Medicare Advantage organization with a Medicare contract. Our contract is renewed annually, and coverage beyond the current contract year is not guaranteed. You must use network providers except for emergencies, urgent care, or out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor Health First Medicare Plans will be responsible for the cost.

• Enrollment form

Member forms

• Vision, dental, and hearing reimbursement form
• Plan option change form
• Prescription mail order form
• Prescription reimbursement form

Last updated: 4/22/2008

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Member newsletter

We can help! Health First Health Plans is here to help you get the prescription drugs you need. If you have a complaint regarding your Part D benefit, please give us the opportunity to resolve your issue by contacting our Customer Service Department: