‍2022 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 are a United States citizen or are lawfully present in the United States.

PrimeTime Health Plan BASIC-MA OnlY (HMO-POS)

This is not a complete description of benefits. 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 lab services, non-Medicare covered dental and vision services, hearing exams and hearing aids. For lab services, members may use the Medicare provider of their choice and services will be paid in-network. Molecular Diagnostics/Genetic testing requires prior authorization. For non-Medicare covered dental and vision services, members may use the provider of their choice and services will be reimbursed up to the plan annual maximum allowed. For hearing exams and/or hearing aids, you can use the provider of your choice, but you may have a higher out-of-pocket cost for hearing aids purchased from non-Amplifon providers.

ENROLLMENT in BASIC-MA

• Members may enroll in the plan only during specific times of the year. Contact PrimeTime Health Plan for more information

2022 Enrollment Forms
HMO-POS Enrollment Form
Electronic Funds Transfer (EFT) Form

ENROLLMENT OPTIONS FOR PRIMETIME HEALTH PLAN

ONLINE

Beginning October 15, 2021, you can complete a secure online enrollment application by continuing with the green button below. I am aware that I am Enrolling in the PrimeTime Health Plan Basic- MA Only (HMO-POS)

• $0 Monthly Premium
• $0 Annual Deductible
• $3,400 Annual Out-of-Pocket Max

By completing this enrollment form, you are sending an actual enrollment election to PrimeTime Health Plan.

You will get an enrollment packet in the mail from PrimeTime Health Plan within seven to ten calendar days of enrolling online.

For more information, contact PrimeTime Health Plan on our Contact Us Page.

IN PERSON

You can visit us during our office hours Monday through Friday from 8:00 a.m. to 4:30 p.m. to drop off your completed enrollment application. Additionally, a PrimeTime Health Plan staff person is available to meet with you to discuss your plan options. You can complete an enrollment application during this appointment or take one with you to fill out and return. To schedule an appointment, please call 330-363-7407 or 1-800-577-5084. TTY users call 711. Our call center is available Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1 – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.).

PrimeTime Health Plan
Morrow House
2600 Sixth St SW
Canton, Ohio 44710

BY MAIL

You can also choose to print and complete an enrollment application. When completed, mail the enrollment application to our office at:

PrimeTime Health Plan
Morrow House
2600 Sixth St SW
Canton, Ohio 44710