Enrollment Instructions and Forms
2010
- 2010 DeanCare Rx Enrollment Application for Prescription Drug Plan (PDF)
- 2010 DeanCare Rx Attestation of Eligibility (PDF)
- 2009 DeanCare Rx Enrollment Application for Prescription Drug Plan (PDF).
- 2009 DeanCare Rx Attestation of Eligibility (PDF).
To be a member of our Plan, you must live in our service area and either be entitled to Medicare Part A or be enrolled in Medicare Part B. If you currently pay a premium for Medicare Part A and/or Medicare Part B, you must continue paying your premium in order to keep your Medicare Part A and/or Medicare Part B and to remain a member of this plan.
For specific details on enrollment periods and which may apply to you,
please contact our Customer Service Department.
You may be enrolled in only one Part D plan at a time. If you are enrolled in a Medicare Advantage (MA) coordinated care (HMO or PPO) plan or a MA Private-Fee-For-Service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a Medicare Prescription Drug Plan (PDP) unless you disenroll from the HMO, PPO or MA PFFS plan.
If you are enrolled in a PFFS plan that does not provide Medicare prescription drug coverage, or a MA Medical Savings Account plan, you may enroll a Medicare PDP. If you are enrolled in a Medicare (1876) Cost Plan, you may enroll in a PDP.
You must use network pharmacies to access network benefits, except in an emergency when you cannot reasonably use network pharmacies. DeanCare Rx covers prescriptions filled at an out-of-network pharmacy in emergency situations. Your copayment may be higher and the prescription will be for a 10 day supply. Please see your Evidence of Coverage for the out of network benefits.
