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Eligiblility Requirements

Who Can Join?

1. To be a member of any Welborn Health Plans (WHP) Medicare Advantage Plans, you must permanently reside in our service area, consisting of the Southwestern Indiana Counties shown below.

Gibson County Posey County Knox County Perry County

Pike County Spencer County Vanderburgh County Warrick County

2. You must be entitled to Medicare Part A and enrolled in Medicare Part B. If you currently pay a premium for Medicare Part A and Medicare Part B, you must continue paying your premium in order to keep your Medicare Part A and/or Medicare Part B and to remain a member of this plan.

3. May not have been diagnosed with End Stage Renal Disease (ESRD) before the proposed effective date of coverage with any of the WHP Medicare Advantage Plans. However, if you already belong to a WHP plan (of any type) and will have no lapse in coverage when moving to one of the Medicare plans, you will be eligible.

4. You or your legal representative completes an enrollment election.

5. The individual makes a valid election during an election period as determined by CMS. See “Enrollment Periods” for details.

6. You have been fully informed of and agrees to abide by the rules of the Plan. Please refer to the Evidence of Coverage (EOC) for details.

7. An eligible individual may not be enrolled in more than one Medicare Advantge plan at any given time.

If you have any questions, please call our Customer Services Department 8:00 a.m. to 8:00 p.m., seven days a week at (800) 521-0265. TTY users call via Indiana Relay (800) 743-3333.

The WHP Medicare Advantage Plans (H3044) will be available for eligible individuals to submit an enrollment application as of October 15th, 2011, for a coverage effective date of January 1st, 2012. Please review Eligibility Requirements

Medicare must review all enrollments. If you decide to enroll we will send your enrollment to Medicare, and they will do a final review. When Medicare finishes its review, we will send youa letter to confirm your enrollment with Welborn Health Plans Medicare Plan you have selected.

Do not cancel any Medigap / Medicare Select or supplemental insurance that you have untilwe send you a confirmation letter stating that Medicare has accepted your application for WHP.

Once enrolled in a plan, you can only make changes during certain times of the year. Annually, between October 15th and December 7th anyone can make any type of change. There may also be special circumstances such as moving out of the Plans service area that would allow you to change plans. Please call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask questions or get free information booklets. TTY users may call 1-877-486-2048. Medicare Customer service representatives are available 24 hours a day, including weekends. You may also visit www.medicare.gov. The official site for Medicare information.

A Coordinated Care Plan with a Medicare Advantage Contract. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium even if the plan premium is $0. Members may enroll in the plan only during specific times of the year. Contact Welborn Health Plans for more information. Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. HMO members must receive all routine care from plan providers. Plans may be renewed annually. Limitations, copayments, and restrictions may apply.

Updated 10/11

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