Enrollment Instructions and Forms
2008
This application is available in alternative formats.
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 facility in emergency situations.
Your copayment is higher and the prescription will be for a 10 day supply. Please
see your Evidence of Coverage for the out of network benefits.
