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1. To be a member of The Welborn Health Plans (WHP) Senior Advantage or Senior Advantage “Plus” Plan, you must permanently reside in our service area, consisting of the Southwestern Indiana Counties shown below.
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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.
H3044_H1558_WHPWeb (10/2009)
