If a state of emergency or disaster is declared in your geographic area, you are still entitled to receive care from your plan. You must pay attention to the media for information from the company on how you will receive the care you need.
At all times, and especially in disaster and/or public health emergency situations, Part D sponsors must ensure that their enrollees have adequate access to covered Part D drugs. The plans shall enable maximum extended day supply, if requested and available at the time of refill. Besides, during the emergency they may exercise operational discretion as to how “refill-too-soon” edits are lifted, as long as access to Part D drugs is provided at the point-of-sale.
If during the emergency, you need to get your medications after being discharged from a hospital, psychiatric hospital or other level of care facility, regardless of the level of care: We will cover one 30-day supply of drugs not included on the Drug List or restricted on the Drug List in some way (preauthorization, step therapy, quantity limits). While you are using the temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. To ask for a temporary supply, call Member Services (phone numbers are printed on your plan ID card).
In the case of a disaster or emergency, your plan will allow you to obtain care from out-of-network providers at the in-network cost sharing. If you are not able to access a network pharmacy due to a disaster, you may take your drug prescription to any pharmacy.
These special conditions will be valid until the emergency or disaster no longer exists or upon the expiration of the 90-day period beginning from the initial declaration, (whichever occurs first.)
Know about your rights as a patient. The Emergency Medical Treatment and Active Labor Act (EMTALA) was originally enacted in 1986 as part of Congress' comprehensive Consolidated Omnibus Budget Reconciliation Act, or COBRA. EMTALA serves to ensure that all patients receive certain basic medical attentions when they present themselves to a federally funded hospital's emergency room, including during a state of emergency.
Medicare y Mucho Más (MMM) (HMO), PMC Medicare Choice (PMC) (HMO) and FIRST+PLUS (PPO), products offered by MMM Healthcare, LLC, are plans with a Medicare contract. Enrollment in the plans depends on contract renewal. To enroll, you must have Medicare Parts A and B, have not been diagnosed with End Stage Renal Disease (ESRD) and reside within the 78 municipalities of the Island. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. 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. MMM Healthcare, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-333-5470. (TTY: 1-866-333-5469). Lunes a domingo, de 8:00 a.m. a 8:00 p.m.
H4003-MMM Healthcare, LLC H4004-PMC Medicare Choice H7522-MMM Healthcare, LLC Y0049_2017 4006 0005 1 Approved
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