• PrimeTime Health Plan is an HMO-POS plan with a Medicare contract. Enrollment in PrimeTime Health Plan depends on contract renewal.
• This information is not a complete description of benefits. Contact the plan for more information.
• Limitations, co-payments, and restrictions may apply.
• Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.
• You must continue to pay your Medicare Part B premium.
• The provider network may change at any time. You will receive notice when necessary.
2018 PrimeTime Health Plan Basic-MA Only (HMO-POS) Eligibility Requirements:
With PrimeTime Health Plan Basic-MA Only (HMO-POS) there are no deductibles to pay. Instead, your cost-sharing consists of co-payments or co-insurances for the services that you receive.
You are eligible for membership in our plan as long as:
• You live in our service area
(Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas, and Wayne Counties)
• --and-- you have both Medicare Part A and Medicare Part B
(When you enroll in a Medicare Advantage Plan, you continue to pay your Medicare Part B premium.)
• --and--you do not have End-Stage Renal Disease (ESRD), with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that was terminated.
For coverage details and additional co-payments/co-insurance please see the Summary of Benefits. Conditions and limitations may apply.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or Your State Medicaid Office.
You must receive your care from a network provider.
In most cases, care you receive from an out-of-network provider (a provider who is not part of plan’s network) will not be covered. There are four exceptions:
• The plan covers emergency care or urgently needed services that you get from an out-of-network provider.
• If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider with our prior approval. In this situation with our approval, you will pay the same as you would pay if you got the care from a network provider.
• The plan covers kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.
• Our plan offers a Point of Service (POS) option for services associated with routine eyewear. For lenses and frames or contacts (except after cataract surgery), you may use a qualified provider of your choice.
*The late enrollment penalty is an amount that is added to your Part D premium. You may owe a monthly late enrollment penalty if at any time after your initial enrollment period is over, there is a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. If you get "Extra Help" you do not pay a late enrollment penalty.
Last updated: 09/10/2018
To be eligible for our HMO-POS PLAN Options:
• Must have Medicare Part A & B
• Must reside in one of the following counties within Ohio
• Only pre-existing ESRD not eligible to join PrimeTime Health Plan
• Members may enroll in the plan only during specific times of the year. Contact PrimeTime Health Plan for more information
Medicare beneficiaries may also enroll with PrimeTime Health Plan through the CMS Medicare Online Enrollment Center located at Medicare.gov
If you have questions or require language assistance, please call Customer Service at 330-363-7407 or 1-800-577-5084. For people who are hearing impaired, please call our TTY line at 330-363-7460 or 1-800-617-7446. Interpreter services are provided free of charge to you. A customer service representative is available to assist you Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)