More Information

Wisconsin Physicians Service Insurance Corporation (WPS Health Insurance) is a Medicare-approved Part D sponsor.

If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join the WPS MedicareRx Plan (PDP), Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay. If you are not getting this extra help, you can see if you qualify by contacting:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days 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, 1-800-325-0778; or
• Your State Medicaid Office.
  

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 (PDP) at:

1-800-731 0459
711 TTY/TDD
8 a.m. - 8 p.m., 7 days a week.

To view performance ratings for the WPS MedicareRx Plan (PDP) visit www.medicare.gov. Benefits, formulary, pharmacy network, premiums, and/or copayments may change on January 1, 2013. Please contact WPS Health Insurance for details.

The benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage.

For Current Members Receiving Extra Help
If you continue to qualify for the same amount of help next year, the table below tells you how your prescription costs will change.

If you qualify for extra help, you pay $0 or a reduced monthly premium.  If you continue to qualify for the same amount of extra help in 2012, the table below tells how much you will pay for a monthly premium. (This doesn’t include any Medicare Part B premium you may have to pay.)  If you don’t know your level of extra help, call us.

You may receive (or may have already received) a letter from Medicare or Social Security about your 2012 eligibility for extra help.  Read this important information carefully. If you don’t know what level of extra help you qualify for, you can call 1-800-MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048.  Customer service representatives are available 24 hours a day, including weekends.

• 2012 WPS MedicareRx Plan (PDP) Monthly Plan Premium
  for People who get Extra Help from Medicare
  to Help Pay for their Prescription Drug Costs

Centers for Medicare & Medicaid Services Best Available Evidence Policy
Federal regulations at 42 CFR § 423.800 specify the requirements of Part D sponsors in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.

To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.

• Go to the CMS website Best Available Evidence Policy page

Claim Forms

• Coordination of Benefits / Direct Claim Form
• Vaccine and Administration (Injection) Claim Form

Important Information and Disclaimers

Additional information about Medicare