2016 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS
Florida Alachua, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, DeSoto, Duval, Escambia, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jefferson, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Lucie, Sumter, Union, Volusia, Wakulla, Walton, Washington Counties H1032 January 1, 2016 - December 31, 2016
WellCare Access (HMO SNP) Plan 124
H1032_FL030109_WCM_SOB_ENG CMS Accepted ©WellCare 2015 FL_05_15
FL6124SOB67497E_0515
Summary of Benefits January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, call us and ask for the "Evidence of Coverage." You have choices about how to get your Medicare benefits 1 One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare is run directly by the Federal government. 1 Another choice is to get your Medicare benefits by joining a Medicare health plan (such as WellCare Access (HMO SNP)). Tips for comparing your Medicare choices This Summary of Benefits booklet gives you a summary of what WellCare Access (HMO SNP) covers and what you pay. 1 If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits booklets. Or, use the Medicare Plan Finder on http://www.medicare.gov. 1 If you want to know more about the coverage and costs of Original Medicare, look in your current "Medicare & You" handbook. View it online at http://www.medicare.gov or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Sections in this booklet 1 1 1 1
Things to Know About WellCare Access (HMO SNP) Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services Covered Medical and Hospital Benefits Prescription Drug Benefits
This document is available in other formats such as Braille and large print. This document may be available in a non-English language. For additional information, call us at 1-877-374-4056, TTY 1-877-247-6272. Este documento puede estar disponible en un idioma diferente al inglés. Para información adicional, llámenos al 1-877-374-4056, TTY 1-877-247-6272. Things to Know About WellCare Access (HMO SNP) Hours of Operation 1 From October 1 to February 14, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Local time. Summary of Benefits | 1
Summary of Benefits 1 From February 15 to September 30, you can call us Monday through Friday from 8:00 a.m. to 8:00 p.m. Local time. WellCare Access (HMO SNP) Phone Numbers and Website 1 If you are a member of this plan, call toll-free 1-866-637-8041, TTY 1-877-247-6272. 1 If you are not a member of this plan, call toll-free 1-866-527-0057, TTY 1-877-247-6272. 1 Our website: www.wellcare.com/medicare Who can join? To join WellCare Access (HMO SNP), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and Florida Agency for Health Care Administration, and live in our service area. Our service area includes the following counties in Florida: Alachua, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, DeSoto, Duval, Escambia, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jefferson, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Lucie, Sumter, Union, Volusia, Wakulla, Walton, and Washington. Which doctors, hospitals, and pharmacies can I use? WellCare Access (HMO SNP) has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs. Some of our network pharmacies have preferred cost-sharing. You may pay less if you use these pharmacies. You can see our plan's provider and pharmacy directory at our website (www.wellcare.com/medicare). Or, call us and we will send you a copy of the provider and pharmacy directories. What do we cover? Like all Medicare health plans, we cover everything that Original Medicare covers - and more. 1 Our plan members get all of the benefits covered by Original Medicare. 1 Our plan members also get more than what is covered by Original Medicare. Some of the extra benefits are outlined in this booklet. We cover Part D drugs. In addition, we cover Part B drugs such as chemotherapy and some drugs administered by your provider. Summary of Benefits | 2
Summary of Benefits 1 You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website, www.wellcare.com/medicare. 1 Or, call us and we will send you a copy of the formulary. How will I determine my drug costs? Our plan groups each medication into one of five "tiers." You will need to use your formulary to locate what tier your drug is on to determine how much it will cost you. The amount you pay depends on the drug's tier and what stage of the benefit you have reached. Later in this document we discuss the benefit stages that occur after you meet your deductible: Initial Coverage, Coverage Gap, and Catastrophic Coverage.
Summary of Benefits | 3
Summary of Benefits January 1, 2016 - December 31, 2016
WellCare Access (HMO SNP) Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services How much is the monthly $0 per month. premium? How much is the deductible? This plan does not have a deductible. Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. In this plan, you may pay nothing for Medicare-covered services, depending on your level of Florida Agency for Health Care Administration eligibility. Your yearly limit(s) in this plan: 1 $6,700 for services you receive from in-network providers. If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Refer to the "Medicare & You" handbook for Medicare-covered services. For Florida Agency for Health Care Administration-covered services, refer to the Medicaid Coverage section in this document. Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.
Is there a limit on how much Our plan has a coverage limit every year for certain in-network the plan will pay? benefits. Contact us for the services that apply.
Summary of Benefits | 4
WellCare Access (HMO SNP) Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services WellCare (HMO SNP) is a Medicare Advantage organization with a Medicare contract and a contract with the Florida Medicaid program. Enrollment in WellCare (HMO SNP) depends on contract renewal. Covered Medical and Hospital Benefits NOTE: 1 SERVICES WITH A 1 MAY REQUIRE PRIOR AUTHORIZATION. 1 SERVICES WITH A 2 MAY REQUIRE A REFERRAL FROM YOUR DOCTOR. Outpatient Care and Services Acupuncture Not covered Ambulance1
You pay nothing
Chiropractic Care1,2
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): You pay nothing Routine chiropractic visit (for up to 12 every year): You pay nothing
Dental Services1,2
Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth): $0 co-pay Preventive dental services: 1 1 1 1
Cleaning (for up to 1 every six months): $0 co-pay Dental x-ray(s) (for up to 1): $0 co-pay Fluoride treatment (for up to 1 every year): $0 co-pay Oral exam (for up to 1 every six months): $0 co-pay
Our plan pays up to $750 every year for most dental services. You pay nothing for additional comprehensive dental services including: DIAGNOSTICS, ENDODONTICS, RESTORATIVE, PERIODONTICS, EXTRACTIONS, PROSTHODONTICS and OTHER ORAL SURGERY. Limitations apply. Diabetes Supplies and Services1,2
Diabetes monitoring supplies: You pay nothing Diabetes self-management training: You pay nothing Summary of Benefits | 5
WellCare Access (HMO SNP) Outpatient Care and Services Diabetes Supplies and Therapeutic shoes or inserts: You pay nothing 1,2 Services Diabetic supplies and services are limited to specific manufacturers. Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may be different if received in an outpatient surgery setting)1,2
Diagnostic radiology services (such as MRIs, CT scans): You pay nothing Diagnostic tests and procedures: You pay nothing Lab services: You pay nothing Outpatient x-rays: You pay nothing Therapeutic radiology services (such as radiation treatment for cancer): You pay nothing
Doctor's Office Visits1,2
Primary care physician visit: You pay nothing Specialist visit: You pay nothing
Durable Medical Equipment You pay nothing (wheelchairs, oxygen, etc.)1 Emergency Care
You pay nothing
Foot Care (podiatry services) Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: You pay nothing
1,2
Hearing Services1,2
Exam to diagnose and treat hearing and balance issues: $0 co-pay Routine hearing exam (for up to 1 every year): $0 co-pay Hearing aid fitting/evaluation (for up to 1 every year): $0 co-pay Hearing aid: $0 co-pay Our plan pays up to $350 every year for hearing aids.
Home Health Care1,2
You pay nothing
Mental Health Care1,2
Inpatient visit:
Summary of Benefits | 6
WellCare Access (HMO SNP) Outpatient Care and Services Mental Health Care1,2 Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital. Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days. You pay nothing Outpatient group therapy visit: You pay nothing Outpatient individual therapy visit: You pay nothing Benefit periods do not apply. Outpatient Rehabilitation1,2 Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): You pay nothing Occupational therapy visit: You pay nothing Physical therapy and speech and language therapy visit: You pay nothing Outpatient Substance Abuse Group therapy visit: You pay nothing
1,2
Individual therapy visit: You pay nothing Outpatient Surgery1,2
Ambulatory surgical center: You pay nothing Outpatient hospital: You pay nothing
Over-the-Counter Items
Please visit our website to see our list of covered over-the-counter items. Our plan will pay up to $25 every month for the purchase of covered over-the-counter items.
Prosthetic Devices (braces, artificial limbs, etc.)1
Prosthetic devices: You pay nothing Related medical supplies: You pay nothing Summary of Benefits | 7
WellCare Access (HMO SNP) Outpatient Care and Services Renal Dialysis1,2 You pay nothing Transportation1,2
You pay nothing Our plan covers up to 24 one-way trips to plan approved locations every year.
Urgently Needed Services
You pay nothing
Vision Services1,2
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0 co-pay Routine eye exam (for up to 1 every year): $0 co-pay Contact lenses (for up to 1 every year): $0 co-pay Eyeglasses (frames and lenses) (for up to 1 every year): $0 co-pay Eyeglass frames (for up to 1 every year): $0 co-pay Eyeglass lenses (for up to 1 every year): $0 co-pay Eyeglasses or contact lenses after cataract surgery: $0 co-pay Our plan pays up to $100 every year for eyewear.
Preventive Care
You pay nothing Our plan covers many preventive services, including: 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Abdominal aortic aneurysm screening Alcohol misuse counseling Bone mass measurement Breast cancer screening (mammogram) Cardiovascular disease (behavioral therapy) Cardiovascular screenings Cervical and vaginal cancer screening Colorectal cancer screenings (Colonoscopy, Fecal occult blood test, Flexible sigmoidoscopy) Depression screening Diabetes screenings HIV screening Medical nutrition therapy services Obesity screening and counseling Prostate cancer screenings (PSA) Summary of Benefits | 8
WellCare Access (HMO SNP) Outpatient Care and Services Preventive Care 1 Sexually transmitted infections screening and counseling 1 Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) 1 Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots 1 "Welcome to Medicare" preventive visit (one-time) 1 Yearly "Wellness" visit Any additional preventive services approved by Medicare during the contract year will be covered. Annual physical exam: You pay nothing Hospice
Inpatient Care Inpatient Hospital Care1,2
You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the costs for drugs and respite care. Hospice is covered outside of our plan. Please contact us for more details.
Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days. You pay nothing Benefit periods do not apply.
Inpatient Mental Health Care
For inpatient mental health care, see the "Mental Health Care" section of this booklet.
Skilled Nursing Facility (SNF)1,2
Our plan covers up to 100 days in a SNF. You pay nothing Our plan covers up to 100 days each benefit period. A benefit period begins the day you go into a skilled nursing facility. The benefit period ends when you haven’t received any skilled care in a SNF for 60 days in a row. There is no limit to the number of benefit periods.
Summary of Benefits | 9
WellCare Access (HMO SNP) Prescription Drug Benefits How much do I pay?
For Part B drugs such as chemotherapy drugs1: You pay nothing Other Part B drugs1: You pay nothing
Initial Coverage
You pay the following: You may get your drugs at network retail pharmacies and mail order pharmacies. Standard Retail Cost-Sharing Tier
One-month supply
Three-month supply
Tier 1 (Preferred $0 $0 Generic) For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or • $1.20 co-pay; or • $1.20 co-pay; or Tier 2 (Generic) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 3 (Preferred • $1.20 co-pay; or • $1.20 co-pay; or Brand) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay.
Summary of Benefits | 10
WellCare Access (HMO SNP) Prescription Drug Benefits Initial Coverage
Three-month supply For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 4 • $1.20 co-pay; or • $1.20 co-pay; or (Non-Preferred • $2.95 co-pay • $2.95 co-pay Brand) For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs Not Offered (including brand drugs treated as generic), either: • $0 co-pay; or Tier 5 (Specialty • $1.20 co-pay; or • $2.95 co-pay Tier) For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. Tier
One-month supply
Standard Mail Order Cost-Sharing Tier
Three-month supply
One-month supply
Tier 1 (Preferred $0 Generic)
Summary of Benefits | 11
$0
WellCare Access (HMO SNP) Prescription Drug Benefits Initial Coverage
Three-month supply For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or • $1.20 co-pay; or • $1.20 co-pay; or Tier 2 (Generic) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 3 (Preferred • $1.20 co-pay; or • $1.20 co-pay; or Brand) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 4 • $1.20 co-pay; or • $1.20 co-pay; or (Non-Preferred • $2.95 co-pay • $2.95 co-pay Brand) For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. Tier
One-month supply
Summary of Benefits | 12
WellCare Access (HMO SNP) Prescription Drug Benefits Initial Coverage
Three-month supply For generic drugs Not Offered (including brand drugs treated as generic), either: • $0 co-pay; or Tier 5 (Specialty • $1.20 co-pay; or • $2.95 co-pay Tier) For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. Tier
One-month supply
Preferred Mail Order Cost-Sharing Tier
One-month supply
Three-month supply
Tier 1 (Preferred $0 $0 Generic) For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or • $1.20 co-pay; or • $1.20 co-pay; or Tier 2 (Generic) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay.
Summary of Benefits | 13
WellCare Access (HMO SNP) Prescription Drug Benefits Initial Coverage
Three-month supply For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 3 (Preferred • $1.20 co-pay; or • $1.20 co-pay; or Brand) • $2.95 co-pay • $2.95 co-pay For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs For generic drugs (including brand (including brand drugs treated as drugs treated as generic), either: generic), either: • $0 co-pay; or • $0 co-pay; or Tier 4 • $1.20 co-pay; or • $1.20 co-pay; or (Non-Preferred • $2.95 co-pay • $2.95 co-pay Brand) For all other drugs, For all other drugs, either: either: • $0 co-pay; or • $0 co-pay; or • $3.60 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. • $7.40 co-pay. For generic drugs Not Offered (including brand drugs treated as generic), either: • $0 co-pay; or Tier 5 (Specialty • $1.20 co-pay; or Tier) • $2.95 co-pay For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. Tier
One-month supply
Summary of Benefits | 14
WellCare Access (HMO SNP) Prescription Drug Benefits Initial Coverage
If you reside in a long-term care facility, you pay the same as at a retail pharmacy. You may get drugs from an out-of-network pharmacy, but may pay more than you pay at an in-network pharmacy.
Catastrophic Coverage
You pay nothing
Summary of Benefits | 15
Ambulance*
Outpatient Care and Services Acupuncture*
Not covered
WellCare Access (HMO SNP)
Summary of Benefits | 16
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Not Covered
Covered Medical and Hospital Benefits
Florida Agency for Health Care Administration
Benefits marked with an asterisk (*) may not be covered for all enrollees and, if covered, may require a co-payment or coinsurance. Only members who have full Medicaid benefit coverage (Full Benefit Dual Eligible, Qualified Medicare Beneficiary-Plus, and Specified Low-Income Medicare Beneficiary-Plus) may receive these benefits.
Coverage of the benefits described below depends upon your level of Medicaid eligibility. No matter what your level of Medicaid eligibility is, WellCare Access (HMO SNP) will cover the benefits described in the Covered Medical and Hospital Benefits section of the Summary of Benefits. If you have questions about your Medicaid eligibility and what benefits you are entitled to call: 1-866-637-8041.
The benefits described below are covered by Medicaid. The benefits described in the Covered Medical and Hospital Benefits section of the Summary of Benefits are covered by Medicare. For each benefit listed below, you can see what Florida Agency for Health Care Administration covers and what our plan covers. What you pay for covered services may depend on your level of Medicaid eligibility.
January 1, 2016 - December 31, 2016
Summary of Medicaid-Covered Benefits
Dental Services*
Chiropractic Care*
Outpatient Care and Services
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): You pay nothing
WellCare Access (HMO SNP)
Summary of Benefits | 17
1 Oral exam (for up to 1 every six months): $0 co-pay
Covered Children Services (Ages under 21)
1 Dental x-ray(s) (for up to 1): $0 co-pay
1 Cleaning (for up to 1 every six months): $0 co-pay
Preventive dental services:
1 Fluoride treatment (for up to 1 every year): $0 co-pay
Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth): You pay nothing
Medicaid will reimburse for medically necessary emergency dental procedures to alleviate pain and/or infection for adult Medicaid recipients. Emergency dental care shall be limited to emergency problem-focused evaluations, necessary radiographs, extractions, and incision and drainage of abscess, for recipients 21 years of age or older.
Covered Adult Services (Ages 21 and Over)
Routine chiropractic visit (for up to 12 $1.00 co-pay per day per provider beneficiary may apply for Medicaid-covered every year): You pay nothing services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
Florida Agency for Health Care Administration
Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may be different if received in an outpatient surgery setting)*
Diabetes Supplies and Services*
Outpatient Care and Services
Summary of Benefits | 18
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
The Medicaid children's dental services program may provide reimbursement for diagnostic services, preventive treatment, restorative, endodontic, periodontal, surgical procedures and extractions, orthodontic treatment, and complete and partial dentures for recipients under age 21.
Florida Agency for Health Care Administration
Lab services: You pay nothing
Diagnostic tests and procedures: You pay nothing
Diagnostic radiology services (such as MRIs, CT scans): You pay nothing
Diabetic supplies and services are limited to specific manufacturers.
Therapeutic shoes or inserts: You pay nothing
Diabetes self-management training: You pay nothing
Diabetes monitoring supplies: You pay nothing
You pay nothing for additional comprehensive dental services including: DIAGNOSTICS, ENDODONTICS, RESTORATIVE, PERIODONTICS, EXTRACTIONS, PROSTHODONTICS and OTHER ORAL SURGERY. Limitations apply.
Our plan pays up to $750 every year for most dental services.
WellCare Access (HMO SNP)
Emergency Care*
Durable Medical Equipment (wheelchairs, oxygen, etc.)*
Doctor's Office Visits*
Outpatient Care and Services
WellCare Access (HMO SNP)
Summary of Benefits | 19
Coinsurance may apply:
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$2.00 co-pay per day per provider per beneficiary may apply for Medicaid-covered services.
For dual-eligible members, Medicaid pays Primary care physician visit: You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is Specialist visit: You pay nothing exhausted.
$1.00 co-pay per day per provider per Outpatient x-rays: You pay nothing beneficiary may apply for Medicaid-covered Therapeutic radiology services (such as services. radiation treatment for cancer): You pay nothing
Florida Agency for Health Care Administration
Foot Care (podiatry services)*
Outpatient Care and Services
WellCare Access (HMO SNP)
Summary of Benefits | 20
$2.00 co-pay per day per provider per beneficiary may apply for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
management service per beneficiary, every three years, if no services were rendered by the podiatrist to the beneficiary during the three years. Subsequent encounters must be reimbursed as established patient evaluation and management services. Medicaid reimburses for routine foot care if the beneficiary is under a physician's care for a metabolic disease, has conditions of circulatory impairment, or has conditions of desensitization of the legs or feet.
The following podiatry services are a benefit Foot exams and treatment if you have diabetes-related nerve damage and/or meet of Florida Medicaid. certain conditions: You pay nothing One new patient evaluation and
Hospital emergency room 5% coinsurance up to the first $300.00 of Medicaid payment for each visit in the emergency room for non-emergency services, not to exceed $15.00.
Florida Agency for Health Care Administration
Outpatient Care and Services Hearing Services*
WellCare Access (HMO SNP)
Cochlear implant services; Diagnostic testing; Hearing aids; Hearing aid evaluations; Hearing aid fitting and dispensing; Hearing aid repairs and accessories; and Newborn hearing screening.
Summary of Benefits | 21
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
1 1 1 1 1 1 1
Medicaid-reimbursable hearing services include:
Medicaid reimburses for hearing services rendered by licensed, Medicaid-participating otolaryngologists, otologists, audiologists and hearing aid specialists.
Our plan pays up to $350 every year for hearing aids.
Hearing aid: $0 co-pay
Hearing aid fitting/evaluation (for up to 1 every year): $0 co-pay
Routine hearing exam (for up to 1 every year): $0 co-pay
The following hearing services are a benefit Exam to diagnose and treat hearing and balance issues: $0 co-pay of Florida Medicaid.
Florida Agency for Health Care Administration
Mental Health Care*
Outpatient Care and Services Home Health Care*
WellCare Access (HMO SNP)
Summary of Benefits | 22
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$2.00 co-pay per day per provider per beneficiary may apply for Medicaid-covered services.
You pay nothing
Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days.
Our plan covers 90 days for an inpatient hospital stay.
Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
Inpatient visit:
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Florida Agency for Health Care Administration
Outpatient Substance Abuse*
Outpatient Rehabilitation*
Outpatient Care and Services
Occupational therapy visit: You pay nothing
Medicaid-covered services include:
Summary of Benefits | 23
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays Group therapy visit: You pay nothing for this service if it is not covered by Individual therapy visit: You pay nothing Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
Physical Therapy (PT), Occupational Therapy (OT), Respiratory Therapy (RT), Physical therapy and speech and language therapy visit: You pay nothing and Speech-Language Pathology (SLP) services
Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): You pay nothing
Benefit periods do not apply.
Outpatient individual therapy visit: You pay nothing
Outpatient group therapy visit: You pay nothing
WellCare Access (HMO SNP)
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Florida Agency for Health Care Administration
Not Covered
$3.00 co-pay for Medicaid-covered services.
Our plan will pay up to $25 every month for the purchase of covered over-the-counter items.
Please visit our website to see our list of covered over-the-counter items.
For dual-eligible members, Medicaid pays Ambulatory surgical center: You pay for this service if it is not covered by nothing Medicare or when the Medicare benefit is Outpatient hospital: You pay nothing exhausted.
WellCare Access (HMO SNP)
Transportation*
Renal Dialysis*
Summary of Benefits | 24
The following Transportation Services are You pay nothing a benefit of Florida Medicaid.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
Prosthetic Devices (braces, artificial For dual-eligible members, Medicaid pays Prosthetic devices: You pay nothing limbs, etc.)* for this service if it is not covered by Related medical supplies: You pay nothing Medicare or when the Medicare benefit is exhausted.
Over-the-Counter Items*
Outpatient Care and Services Outpatient Surgery*
Florida Agency for Health Care Administration
Urgently Needed Services*
Outpatient Care and Services Our plan covers up to 24 one-way trips to plan approved locations every year.
WellCare Access (HMO SNP)
Summary of Benefits | 25
$0 co-pay for Medicaid-covered services.
For Dual-eligible Members, Medicaid pays You pay nothing for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
All transportation must be the most cost-effective and appropriate method of transportation available. Emergency transportation does not require authorization but the ambulance provider must document the medical necessity of the emergency and keep that documentation on file for every Medicaid beneficiary.
NEMT services are scheduled through the Community Transportation Coordinator (CTC) in each county under contract with the Commission for the Transportation Disadvantaged.
Non-Emergency Medical Transportation (NEMT) services are available only to eligible beneficiaries who cannot obtain transportation through any other means (such as family, friends or community resources).
Florida Agency for Health Care Administration
Preventive Care*
Outpatient Care and Services Vision Services*
WellCare Access (HMO SNP)
Eyeglass frames (for up to 1 every year): $0 co-pay
Eyeglasses (frames and lenses) (for up to 1 every year): $0 co-pay
Contact lenses (for up to 1 every year): $0 co-pay
Summary of Benefits | 26
For dual-eligible members, Medicaid pays You pay nothing for this service if it is not covered by Our plan covers many preventive services, Medicare or when the Medicare benefit is including: exhausted. 1 Abdominal aortic aneurysm screening
Eyeglass lenses (for up to 1 every year): $0 For dual-eligible members, Medicaid pays co-pay for this service if it is not covered by Eyeglasses or contact lenses after cataract Medicare or when the Medicare benefit is surgery: $0 co-pay exhausted. Our plan pays up to $100 every year for $2.00 co-pay per day per provider per eyewear. beneficiary may apply for Medicaid-covered services.
beneficiaries who have unilateral aphakia or bilateral aphakia; and 1 Eyeglasses are limited to no more than two pairs of eyeglasses per beneficiary, per 365 days, based on medical necessity as determined by a medical professional. 1 All special eyeglasses and contact lenses must be prior authorized.
Exam to diagnose and treat diseases and conditions of the eye (including yearly Medicaid reimbursement for visual services glaucoma screening): $0 co-pay Routine eye exam (for up to 1 every year): has the following limitations: $0 co-pay 1 Contact lenses are limited to The following vision services are a benefit of Florida Medicaid.
Florida Agency for Health Care Administration
Outpatient Care and Services
Summary of Benefits | 27
1 Written health education materials, including Newsletters 1 Nutritional Training 1 Additional Smoking Cessation
Health/Wellness Education
WellCare Access (HMO SNP)
Alcohol misuse counseling Bone mass measurement Breast cancer screening (mammogram) Cardiovascular disease (behavioral therapy) Cardiovascular screenings Cervical and vaginal cancer screening Colorectal cancer screenings (Colonoscopy, Fecal occult blood test, Flexible sigmoidoscopy) Depression screening Diabetes screenings HIV screening Medical nutrition therapy services Obesity screening and counseling Prostate cancer screenings (PSA) Sexually transmitted infections screening and counseling Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) 1 Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots 1 "Welcome to Medicare" preventive visit (one-time) 1 Yearly "Wellness" visit
1 1 Bone Mass Measurement (for people with Medicare who are at risk) 1 1 Colorectal Screening Exams (for people with Medicare age 50 and older) 1 1 Immunizations 1 (Flu vaccine, Hepatitis B vaccine - for people with Medicare who are at risk, Pneumonia vaccine) 1 Mammograms (Annual Screening) 1 (for women with Medicare age 40 and 1 older) 1 Pap Smears and Pelvic Exams 1 (for women with Medicare) 1 1 Prostate Cancer Screening Exams (for men with Medicare age 50 and older) 1 Welcome to Medicare; and Annual Wellness Visit
$0 co-pay for Medicaid-covered services.
Florida Agency for Health Care Administration
Inpatient Care Inpatient Hospital Care*
Hospice*
Outpatient Care and Services
Summary of Benefits | 28
$3.00 co-pay per admission may apply for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
1 Other Wellness Benefits
Florida Agency for Health Care Administration
Benefit periods do not apply.
You pay nothing
Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days.
Our plan covers 90 days for an inpatient hospital stay.
You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care. Hospice is covered outside of our plan. Please contact us for more details.
Annual physical exam: You pay nothing
Any additional preventive services approved by Medicare during the contract year will be covered.
WellCare Access (HMO SNP)
How much do I pay?
Prescription Drug Benefits Prescription Drugs*
Skilled Nursing Facility (SNF)*
Inpatient Care Inpatient Mental Health Care*
WellCare Access (HMO SNP)
Summary of Benefits | 29
Not Applicable
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
For Part B drugs such as chemotherapy drugs1: You pay nothing
For dual-eligible members, Medicaid pays Our plan covers up to 100 days in a SNF. for this service if it is not covered by You pay nothing Medicare or when the Medicare benefit is Our plan covers up to 100 days each benefit exhausted. period. A benefit period begins the day you $0 co-pay for Medicaid-covered services. go into a skilled nursing facility. The benefit period ends when you haven’t received any skilled care in a SNF for 60 days in a row. There is no limit to the number of benefit periods.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays For inpatient mental health care, see the for this service if it is not covered by "Mental Health Care" section of this Medicare or when the Medicare benefit is booklet. exhausted.
Florida Agency for Health Care Administration
Initial Coverage
Prescription Drug Benefits
Summary of Benefits | 30
Not Applicable
Florida Agency for Health Care Administration
Standard Retail Cost-Sharing ThreeOne-month month Tier supply supply $0 $0 Tier 1 (Preferred Generic)
You may get your drugs at network retail pharmacies and mail order pharmacies.
You pay the following:
Other Part B drugs1: You pay nothing
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 31
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 2 co-pay; or co-pay; or (Generic) • $2.95 • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 32
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 3 (Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 33
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 4 (Non-Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 34
Florida Agency for Health Care Administration
ThreeTier month supply For generic Not Offered drugs (including brand drugs treated as generic), either: • $0 co-pay; or Tier 5 • $1.20 (Specialty co-pay; or Tier) • $2.95 co-pay For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 35
Florida Agency for Health Care Administration
Standard Mail Order Cost-Sharing ThreeOne-month month Tier supply supply Tier 1 $0 $0 (Preferred Generic)
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 36
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 2 co-pay; or co-pay; or (Generic) • $2.95 • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 37
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 3 (Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 38
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 4 (Non-Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 39
Florida Agency for Health Care Administration
Threemonth Tier supply For generic Not Offered drugs (including brand drugs treated as generic), either: • $0 co-pay; or • $1.20 Tier 5 (Specialty co-pay; or • $2.95 Tier) co-pay For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 40
Florida Agency for Health Care Administration
Preferred Mail Order Cost-Sharing ThreeOne-month month Tier supply supply Tier 1 $0 $0 (Preferred Generic)
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 41
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 2 co-pay; or co-pay; or (Generic) • $2.95 • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 42
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 3 (Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 43
Florida Agency for Health Care Administration
Threemonth Tier supply For generic For generic drugs drugs (including (including brand drugs brand drugs treated as treated as generic), generic), either: either: • $0 co-pay; • $0 co-pay; or or • $1.20 • $1.20 Tier 4 (Non-Preferred co-pay; or co-pay; or • $2.95 Brand) • $2.95 co-pay co-pay For all other For all other drugs, either: drugs, either: • $0 co-pay; • $0 co-pay; or or • $3.60 • $3.60 co-pay; or co-pay; or • $7.40 • $7.40 co-pay. co-pay. One-month supply
WellCare Access (HMO SNP)
Prescription Drug Benefits
Summary of Benefits | 44
Florida Agency for Health Care Administration
If you reside in a long-term care facility, you pay the same as at a retail pharmacy.
Threemonth Tier supply For generic Not Offered drugs (including brand drugs treated as generic), either: • $0 co-pay; or • $1.20 Tier 5 (Specialty co-pay; or • $2.95 Tier) co-pay For all other drugs, either: • $0 co-pay; or • $3.60 co-pay; or • $7.40 co-pay. One-month supply
WellCare Access (HMO SNP)
$3.00 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$3.00 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Not Applicable
Not Applicable
Summary of Benefits | 45
$0 co-pay for Medicaid-covered services.
Mental Health Case Management* For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Federally Qualified Health Centers*
Additional Benefits Cardiac and Pulmonary Rehabilitation Services*
Catastrophic Coverage
Coverage Gap
Prescription Drug Benefits
Florida Agency for Health Care Administration
You pay nothing
You may get drugs from an out-of-network pharmacy, but may pay more than you pay at an in-network pharmacy.
WellCare Access (HMO SNP)
Rural Health Centers*
Registered Physical Therapist*
Physician Assistant Services*
Additional Benefits Nurse Practitioner*
Summary of Benefits | 46
$3.00 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$2.00 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$2.00 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Florida Agency for Health Care Administration WellCare Access (HMO SNP)
Clinic Services*
Additional Benefits Assistive Care Services*
Summary of Benefits | 47
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
$0 co-pay for Medicaid-covered services.
For dual-eligible members, Medicaid pays for this service if it is not covered by Medicare or when the Medicare benefit is exhausted.
Florida Agency for Health Care Administration WellCare Access (HMO SNP)
Multi-Language Insert Multi-language Interpreter Services
English: We have free interpreter services to answer any questions you may
have about our health or drug plan. To get an interpreter, just call us at 1 877-374-4056. Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de interprete sin costo alguno para responder
cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un interprete, por favor llame al 1-877-374 4056. Alguien que hable espanol le podra ayudar. Este es un servicio gratuito. Chinese Mandarin: iX:{l'l1~{~%'ffl:B"Jl:JlEM~~, rJ=iJ o Po*1~~~rttl~1~ij~~, o
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iF!JfJ:EE! 1-877-374-40560 iX:{[']Er99=rJtI {'f AI7HlUk~:m@1~
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Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang
masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa 1-877-374-4056. Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interpretation pour repondre a toutes VOS questions relatives a notre regime de sante OU d'assurance medicaments. Pour acceder au service d'interpretation, ii vous suffit de nous appeler au 1-877-374-4056. Un interlocuteur parlant Franc;ais pourra vous aider. Ce service est gratuit.
de
Vietnamese: Chung toi c6 dich Vl,J thong dich mi@n phf tra loi cac cau h6i ve chu'dng sue kh6e va chu'dng tr1nh thuoc men. Neu quf vi can thong dich vien xin gc;>i 1-877-374-4056 se c6 nhan vien n6i tieng Vi~t giup do quf vi. Day la dich v1,J mi@n phf . German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher Y0070_NA030775_WCM_INS_MLT CMS Accepted 08052015 ©WellCare 2015 NA 07 15 CCP
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erreichen Sie unter 1-877-374-4056. Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos.
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E disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Perun interprete, contattare ii numero 1-877-374-4056. Un nostro incaricato che parla Italianovi fornira l'assistenza necessaria. E un servizio gratuito.
Italian:
Portugues: Dispomos de servic;os de interpretac;ao gratuitos para responder a qualquer questao que tenha acerca do nosso piano de saude ou de medicac;ao. Para obter um interprete, contacte-nos atraves do numero 1 877-374-4056. Ira encontrar alguem que fale o idioma Portugues para o ajudar. Este servic;o e gratuito.
French Creole: Nou genyen sevis entepret gratis pou reponn tout kesyon OU ta genyen konsenan plan medikal oswa dwog nou an. Pou jwenn yon entepret, jis rele nou nan 1-877-374-4056. Yon moun ki pale Kreyol kapab ede w. Sa a se yon sevis ki gratis. skorzystanie z us~ug Uumacza ustnego, kt6ry pomoze w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania lek6w. Aby skorzystac z pomocy Uumacza znajq_cego j~zyk
Polish: Umozliwiamy
bezp~atne
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polski, nalezy zadzwonic pod numer 1-877-374-4056. Ta us~uga jest bezp~atna.
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Japanese:
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www.wellcare.com/medicare
