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| Molina Medicare |
| Evidence of Coverage |
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| We are pleased that you’ve chosen
Molina Medicare for your healthcare. |
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| This booklet explains how to get your
Medicare services through Molina Medicare. |
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This booklet, together with your enrollment
form
and any amendments that we may send to you, is our contract
with you. It explains your rights, benefits, and responsibilities
as a member of
Molina Medicare. It also explains our responsibilities
to you. The information in this booklet is
in effect for the time period from January 1, 2008,
through December 31, 2008. |
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You are still covered by Original
Medicare, but you are getting your Medicare services
as a
member of Molina Medicare. This booklet gives you the
details, including: |
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What is covered in Molina Medicare
and what is not covered. |
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How to get the care you need, including some
rules you must follow. |
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What you will have to pay for your health plan. |
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What to do if you are unhappy about something
related to getting your covered services. |
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How to leave Molina Medicare, and other Medicare
options that are available. |
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If our records show that you qualify
for extra help in paying for your prescription drug
coverage,
then you will receive help in the form of a Low Income
Subsidy (LIS) for your prescription drug
co-payments. |
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As a member of our Plan, you will
receive the same coverage as someone who is not getting
extra help. Your membership in our Plan will not be
affected because you are getting extra help
in paying for your prescription drug coverage. This
also means that you must follow all the rules
and procedures in this Evidence of Coverage booklet. |
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| If you need to receive this booklet
in a different format (such as in Spanish), please call
us so we
can send you a copy. |
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| Please tell us how we’re doing. |
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| For help or information, please
e-mail us or call Member Services at
1-800-665-3072, TTY/TDD 1-800-346-4128
(Hours of Operation: Monday
through Sunday 8:00 a.m. to 8:00 p.m.).
Calls to these numbers are free. |
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| Molina Medicare is an organization with a
Medicare contract. This contract is renewed annually,
and coverage beyond the end of the contract year is not
guaranteed. |
