Horizon will comply with the BAE policy when situations arise that result in incorrect low income subsidy/cost sharing data at the point of sale. The Centers for Medicare & Medicaid Services (CMS) created the Best Available Evidence (BAE) policy to address incorrect low subsidy/extra help cost sharing data in the electronic data systems of CMS. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at. To be eligible for Medicare Advantage, you must be entitled to Medicare benefits under Part A or enrolled in Part B and reside in New Jersey. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.Ī transition supply will also be available to you if you should have a change in your treatment setting, such as going from a hospital to home care. We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with a 31-day transition supply, consistent with the dispensing increment, (unless you have a prescription written for fewer days). After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.įor each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. For example, you may need a prior authorization from us before you can fill your prescription. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. , you pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $7,400.Īfter your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reaches $7,400, you pay the greater of:įor generic (including brand drugs treated as generic) and an $10.35 CopayĪs a new or continuing member in our plan you may be taking drugs that are not on our formulary. You may get drugs from an out-of-network pharmacy, but may pay more than you pay at an in-network pharmacy.īegins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,660. If you reside in a long-term facility, you pay the same as at a retail pharmacy. Tier 4 (Non-Preferred Drug): 40% of the cost.Tier 5 (Specialty Tier): 25% of the cost.$505 per year for Part D prescription drugs. If you have any questions about your specific benefits, please call your Health Plan.Eligibility Information & Enrollment Instructions If you need a new HBID Card because it was lost or stolen contact 1-87. The provider will know the benefit package and how to bill for the services when both cards are presented. It is important that you bring both cards any time you see your provider. That are provided by their Health Plan such as doctor, hospitalization, dental, prescriptions, etc. A member must use that specific card to access the services The other five cards below come from the Managed Care Organization or the Health Plan/HMO that you are enrolled in. The old card will be reactivated by the State.įee for Service means it is a benefit not covered by the Health Plan or HMO. If you were enrolled in NJ Famil圜are within the past two years, a new card is not generally mailed out. New eligibility does not necessarily mean a new card is being mailed to you. This HBID card is activated or deactivated at the State depending on your eligibility. Service benefits that are part of every NJ Famil圜are health benefit package. The card below, the permanent Health Benefits Identification card (HBID), is what you use to access the Fee for For higher income families with children, there is a sliding scale for copayments. NJ Famil圜are offers the benefits of free or low-cost healthcare coverage and peace of mind knowing that you don't have to
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |