Disclaimers

You are eligible to enroll in this plan if you are entitled to Medicare benefits under Part A and/or enrolled in Part B and reside in Wisconsin. Eligible individuals may only enroll in one Medicare Prescription Drug Plan at a time and may not be enrolled in a Medicare Advantage Plan (HMO, PPO), unless they are a member of Medicare Private-Fee-For-Services plan or are enrolled in an 1876 Cost Plan.

Members may enroll in a plan only during specific times of the year. To obtain more information about these dates please call 1-800-731-0459 (1-888-877-2837 TTY/TDD), 8 am – 8 pm, 7 days a week.

Retail, mail order LTC, I/T/U, and home infusion pharmacies are included in the plan network. For more information on mail order prescription drug service call 1-800-731-0459 (1-888-877-2837 TTY/TDD), 8 am – 8 pm, 7 days a week.

You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, (24 hours a day/7 days a week), or
• The Social Security Administration at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday (TTY/TDD users should call 1-800-325-0778), or
• Your State Medicaid Office.

For general information about Medicare Prescription Drug Coverage call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Wisconsin Physicians Service Insurance Corporation is authorized by law to refuse to renew its contract with CMS. CMS also may refuse to renew the contract. Termination or non-renewal of this contract may result in termination of the beneficiary’s enrollment in the WPS MedicareRx Plan. In addition, the WPS MedicareRx Plan may reduce its service area and no longer offer services in the area where you reside.

Wisconsin Physicians Service Insurance Corporation contracts with the Federal Government to provide this Medicare Prescription Drug Plan.

If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. When you join the WPS MedicareRx Plan, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you aren’t getting any extra help, you can see if you qualify by calling:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, or
• your State Medicaid Office, or
• the Social Security Administration at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY/TDD users should call 1-800-325-0778.

The WPS MedicareRx Plan has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. The WPS MedicareRx Plan may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a Pharmacy Directory or call Customer Service for an up-to-date list.

Benefits, formulary, pharmacy network, premium, copayments and/or coinsurance may change on January 1, 2009. Please contact the WPS MedicareRx Plan for details.

Medicare beneficiaries may enroll in the WPS MedicareRx Plan through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information contact the WPS MedicareRx Plan at 1-800-731-0459 (1-888-877-2837 TTY/TDD), 8 am – 8 pm, 7 days a week.

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