Usually, we only cover drugs obtained from an out-of-network pharmacy in limited circumstances:
For detailed information consult your plan’s Evidence of Coverage (Chapter 5, Using the plan’s coverage for your Part D prescription drugs, Section 2.5 “When can you use a pharmacy that is not in the plan’s network?”) or call our Member Services.
Please note that if you do go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your copay) when you fill your prescription. You can request a reimbursement for our share of the cost by submitting a claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy, as any amount you pay will help you qualify for catastrophic coverage.
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. MMM Healthcare, LLC cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a MMM al 1-866-333-5470, (TTY: 1-866-333-5469); PMC al 1-866-516-7700 (TTY: 1-866-516-7701); y First+Plus al 1-888-767-7717 (TTY: 1-877-672-4242). MMM Healthcare, LLC遵守 用的 邦民 法律 定，不因 族 適聯權規種色、民族血 、年 、 障 或性 而歧 任何人。注意：如果您使用繁 中文，您可以免 得 言援助服 。 致 膚統齡殘別視體費獲語務請電MMM 1-866-333-5470, (TTY: 1-866-333-5469); PMC 1-866-516-7700 (TTY: 1-866-516-7701); First+Plus 1-888-767-7717 (TTY: 1-877-672-4242).
H4003-MMM Healthcare, LLC H4004-PMC Medicare Choice H7522-MMM Healthcare, LLC Y0049_2017 4006 0005 1 Approved
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