Regarding DeanCare Gold (Cost) Plans
About DeanCare Gold
Limitations, copayments and restrictions may apply. Benefits, network premium and/or copayments/coinsurance may change on January 1, 2017. You must continue to pay your Part B premium. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Dean Health Plan. Dean Health Plan contracts with the federal government.
By law, DeanCare Gold can choose not to renew its Medicare contract. Medicare may also refuse to renew the DeanCare Gold contract, resulting in a termination or non-renewal. This may result in termination of the beneficiary's enrollment in DeanCare Gold. In addition, DeanCare Gold may reduce its service area and no longer offer services in the area where the beneficiary resides.
The Medicare program rates how well plans perform in different categories, such as customer service, detecting and preventing illness and ratings from patients, among others. You can use the web tools at The Official U.S. Government Site for Medicare to compare the plan ratings for Medicare plans in your area or click here to see how Dean Health Plan rates. To obtain a copy of the plan ratings you may also call Medicare directly at (800) MEDICARE (633-4227), or TTY call (877) 486-2048 (24 hours a day/7 days a week).
Complaints, Grievances and Appeals
Federal law guarantees your right to make complaints if you have concerns or problems with any part of your medical care as a plan member. The Medicare program has helped set the rules about what you need to do to make a complaint and what we are required to do when someone makes a complaint. A grievance is any complaint other than one that involves a coverage determination. You would file a grievance if you have any type of problem with us or one of our network providers not relating to coverage from the plan. An appeal is any of the procedures that deal with the review of an unfavorable coverage determination. You cannot request an appeal if we have not issued a coverage determination. If we issue an unfavorable coverage determination, you may file an appeal called a "redetermination" if you want us to reconsider and change our decision. If our redetermination decision is unfavorable, you have additional appeal rights. More information regarding this process can be found in Chapter 7 of your plan's Evidence of Coverage (Enhanced / Enhanced with State Rx / Shared Value / Basic).
If you would like to request an organization determination or make an appeal, you may make your request in writing or verbally. The mailing address to send your written requests is:
Dean Health Plan
1277 Deming Way
Madison, WI 53717
You may also submit your organization determination or appeal request by telephone by calling the Customer Care Center at (888) 422-3326 (TTY: 711). (Calls to these numbers are free.)
You may also fax your request to: (608) 830-5920.
If you have questions on this process or wish to check the status of your request for an organization determination or appeal you can call our Customer Care Center at the numbers above.
If you wish, you can name another person your “representative”, which allows them to request an organization determination or make an appeal on your behalf. If you want a friend, relative, provider, or other person to be your representative, call the Customer Care Center at the number above and ask for the Appointment of Representative form. When you complete that form, that person will have permission to act on your behalf. The form must be signed by you and by the person who you would like to act on your behalf. You must give our plan a copy of the signed form. There may be someone who is already legally authorized to act as your representative under State law. If that is the case, a copy of such legal authorization needs to be provided to our plan. You can also download a copy of the Appointment of Representative form required to grant this permission to an individual of your choosing.
You Have Choices in Your Health Care
DeanCare Gold is a Medicare approved HMO. You must use plan providers, except for emergency and urgent care, or when you receive a referral to a non-plan provider. You may receive services from non-plan providers for other than these situations, but you will be responsible for payment of all Medicare deductibles and co-insurance, as well as any other charges prescribed by the Medicare program. DeanCare Gold materials are available in alternative formats.
Medicare Cost Insurance
The Wisconsin Insurance Commissioner has set minimum standards for Medicare Cost insurance. These plans meet these standards. For an example of these standards and other important information, see the "Wisconsin Guide to Health Insurance for People with Medicare." Do not buy this plan if you did not get that guide.
Dean Health Plan, Inc. is Contracted with Medicare to Provide Medicare Benefits
DeanCare Gold offers three plans, an Enhanced plan, a Shared Value plan, and a Basic plan. The Basic plan provides only basic Medicare-covered hospital and physician benefits. The Enhanced and Shared Value plans also provide basic Medicare-covered benefits, but include benefits beyond those provided by Medicare (such as, but not limited to, routine hearing and vision tests, routine physical exams and hearing aids). Please contact our Customer Care Center at (888) 422-3326 (TTY: 711), for additional information about these plans.
Right to Disenroll from Plan
You may disenroll from DeanCare Gold at any time for any reason. However, it may take a few weeks to process your disenrollment, update your Medicare record and return you to the Original Medicare program. Your disenrollment will become effective on the day you return to Original Medicare or enroll in another Medicare plan. You will receive written confirmation from Dean Health Plan, Inc. of your disenrollment effective date, and Dean health Plan, Inc. will return any paid, unused premium to you.
Read Your Evidence of Coverage Carefully
The plan comparisons on this website are only summaries describing DeanCare Gold's most important features. The Evidence of Coverage is the insurance contract. You must read the Evidence of Coverage itself to understand all of the rights and duties of both you and Dean Health Plan, Inc.
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