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WINhealth Partners Medicare Part D Prescription Drug Plans WINhealth Partners offers Medicare Part D prescription drug benefits on the Standard and Plus plans. For both plans, the member pays a monthly premium in addition to Medicare Part B and applicable copayments/coinsurance. Call to learn more about the WINhealth Partners Medicare health plans: 800-946-6952, 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday. Part D benefit questions: 8:00 a.m. to 8:00 p.m., Mountain Time, seven days a week (except Thanksgiving and Christmas). If you are hearing impaired and use TTY equipment, call 800-704-6370, toll free. Medicare Part D Covered Drugs You can learn more about the prescription drugs covered under the Part D plans. Click here to see the comprehensive list of prescription drugs covered on the WINhealth Partners Part D plans. This list will also explain the copayment or tier level applicable to the drugs you take (for example: generic, preferred brand, non-preferred brand). Click here for the WINhealth Partners Medicare Prescription Drug Transition . Participating Pharmacies Click here to see the Pharmacy Directory, the list of contracting pharmacies that you must use for the WINhealth Partners Part D drug benefits. WINhealth Partners has contracts with pharmacies that equals or exceeds CMS requirements for pharmacy access in your area. This document will give you more information about the number of pharmacies in the network, and the pharmacy addresses and types of pharmacies that you may utilize to access your prescription drugs through WINhealth Partners Part D plans. Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the plan's service area where there is no network pharmacy. In addition to paying the copayments/coinsurances for the drugs, you will be required to pay the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions. Extra Help There is extra help available for persons with limited incomes and resouces: If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and costs at the pharmacy will be less. Once you have enrolled in a WINhealth Partners Part D Prescription Drug Plan, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-Medicare(TTY/TDD users should call 877-486-2048) 24 hours a day, 7 days a week, your State Medicaid Office, or the Social Security Administration at 1-800-772-1213 or on the toll free TTY/TDD number, 1-800-325-0778, between 7:00 a.m. and 7:00 p.m. Monday through Friday, to see if you might qualify. Click here for the Premium Summary Table for those receiving extra help Additional Information Available to Beneficiaries There is additional information available to Medicare beneficiaries about WINhealth Partners Medicare Part D Plans. Click here to see the member "2008 Evidence of Coverage." (Coming soon) This document provides more detailed information about: *Coverage associated with receipt or use of benefits
To obtain an aggregate number of the plan's grievances, appeals, and exceptions please call the WINhealth Partners Medicare Customer Service. Click here to see the copy of the Preauthorization Form physicians use to preauthorize your prescription drugs. Click here to see the copy of the Medicare Prescription Drug Determination Request Form: Click here to see the copy of the Formulary Exception Request Form used by physicians to send supporting statements for exception requests. WINhealth Partners offers Medication Therapy Management Programs to our Members. Medication Therapy Management Programs (MTM) are available to all Medicare Part D Members who meet the limited criteria. They are designed to assist Members in optimizing their medication therapies. This program combines the services of the Health Plans clinical pharmacists and other registered pharmacists with medication data from WINhealth Partners and is provided at NO CHARGE to our Members. MTM services are voluntary and the program is not considered a benefit of your plan. Contact WINhealth Partners Medicare Customer Service for additional information. Appeals Call WINhealth Partners Medicare Customer Service for information on how to file or check on the status of an appeal at 800-840-2211, 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday. Part D benefit questions: 8:00 a.m. to 8:00 p.m., Mountain Time, seven days a week (except Thanksgiving and Christmas). If you are hearing impaired and use TTY equipment, call 800-704-6370, toll free. If you wish to authorize another individual to make request or present informatin to us on your behalf, you must complete the Appointment of Representation form and send it to P.O. Box 60160, Grand Junction, CO 81506 Click here for WINhealth Partners' privacy notice. Other Links Click here to see the WINhealth Partners Medicare Formulary for prescription drugs Click here to find answers to some Frequently Asked Questions about our Medicare plans. Employers and Brokers, click here to learn about Medicare Plans for Retirees Click here to see the WINhealth Partners Medicare Service Area Map Click here to see the full list of Medicare Disclaimers Information is current as of 12/10/07, Please call to confirm that you have the most up-to-date information about our Medicare Part D plans:
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