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Medicare Disclaimers (DSNP)

Centers Plan for Healthy Living is an HMO with Medicare and Medicaid contracts. Enrollment in Centers Plan for Healthy Living depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The benefit information provided is a brief summary, not a complete description of benefits. Contact the plan for more information.  You must continue to pay your Medicare Part B premium, unless otherwise paid by Medicaid. For more information, contact the plan.  The formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary.  

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.  Medicare beneficiaries may also enroll in Centers Plan for Healthy Living through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Dual eligible members may enroll all year round.  Members must receive all routine care from plan providers.  

Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Centers Plan for Healthy Living has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2018 based on a review of Centers Plan for Healthy Living’s model of care.  You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-877-486-2048; or Your State Medicaid Office

This information is available for free in other languages. Please contact our Member Services number 1-877-940-9330 for additional information.

(TTY users should call 1-800-421-1220). Hours are from 8:00 A.M. to 8:00 P.M. seven days a week. Member services also has free language interpreter services available for non-English speakers.

Esta información esta disponible gratis en otros idiomas. Comuniquese con nuestro Servicio para Miembros at 1-877-940-1220 obtener información adicional, (los usuarios de TTY deben llamar al 1-800-421-1220) de 8:00 A.M. a 8:00 P.M. siete dias a la semana. Los Servicios para Miembros tambien tienen servicios de interpretes de idiomos gratis disponibles para las personas que no hablan ingels.

Members must receive all routine care from plan providers.

In general, members must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quality limitations and restrictions may apply.

NOTICE OF NONDISCRIMINATION

Discrimination is Against the Law

Centers Plan for Healthy Living, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Centers Plan for Healthy Living, LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Centers Plan for Healthy Living, LLC provides:

  • Free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact Member/Participant Services at 1-844-274-5227 (TTY users please call 1-800-421-1220 or 711).
If you believe that Centers Plan for Healthy Living, LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Grievances and Appeals Department:

By Mail: Centers Plan for Healthy Living, LLC
Attn: G&A Department
75 Vanderbilt Avenue
Staten Island, NY 10304- 2604

By Phone: 1-844-274-5227 (TTY users call 1-800-421-1220)

By Fax: 1-347-505-7089

By Email: GandA@centersplan.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Member/Participant Services is available to help you seven days a week from 8am to 8pm.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

H6988_MKT4006 CMS Approved 11102016

 

Language Assistance Services Notification

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-940-9330 (TTY: 1-800-421-1220).

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-877-940-9330 (TTY: 1-800-421-1220).

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-877-940-9330 (رقم هاتف الصم والبكم: 1-800-421-1220).

লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। ফোন করুন ১-877-940-9330 (TTY: ১-800-421-1220)।

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-877-940-9330(TTY:1-800-421-1220)。

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-877-940-9330 (ATS : 1-800-421-1220).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-877-940-9330 (TTY: 1-800-421-1220).

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-877-940-9330 (TTY: 1-800-421-1220).

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-877-940-9330 (TTY: 1-800-421-1220).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-877-940-9330 (TTY: 1-800-421-1220)번으로 전화해 주십시오.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-877-940-9330 (TTY: 1-800-421-1220).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-940-9330 (телетайп: 1-800-421-1220).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-940-9330 (TTY: 1-800-421-1220).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-940-9330 (TTY: 1-800-421-1220).

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-877-940-9330 (TTY: 1-800-421-1220).

אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. רופט 1-877-940-9330 (TTY: 1-800-421-1220).

H6988_MKT4006 CMS Approved 12282017