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.
This booklet gives you the
details about:
What is covered in Molina Medicare
and what is not covered.
How to get the care you need, including some
rules you must follow.
What you will have to pay for your health plan.
What to do if you are unhappy about something
related to getting your covered services.
How to leave Molina Medicare, and other Medicare
options that are available.
As a member of Molina Medicare, you qualify for extra help in paying for your
prescription drug coverage and will receive help in the
form of a Low Income Subsidy (LIS) for your prescription
drug co-payments.
You must follow all the
rules and procedures in this Evidence of Coverage
booklet.
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.
Please tell us how we’re doing.
We want to hear from you about how
well we are doing as your health plan. You can call or
write to us at any time.
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.
