Healthy Living Extra | winter 2008

When to Seek Emergency Treatment

It's important to know when to use the emergency room. The following guidelines can help.

  • Use the emergency room only if you have an accident or sudden, life-threatening illness that could cause serious jeopardy to your health or might seriously impair your bodily functions.
  • If you believe not seeking treatment would result in serious dysfunction of any bodily organ or part, seek help immediately.
  • If you have an illness such as bronchitis or an earache, call your physician of choice (POC) before you go to the emergency room.
  • If you suffer from a cold, the flu, laryngitis, strep throat, or headaches, contact your POC first. Your POC is the best resource to help you determine the care you need. In an emergency, always go to the nearest emergency room immediately or call 911.

    You may get covered emergency medical care whenever you need it, anywhere in the United States, or anywhere in the world. (See the benefits chart in your Evidence of Coverage for more detailed information about worldwide coverage.) Ambulance services are covered in situations where other means of transportation in the United States would endanger your health.

  • As soon as possible, please notify us of your emergency, because we need to follow up on your emergency care. You or someone else should call Member Services at 1-800-316-CARE (2273) within 48 hours.

If you have any questions about the emergency medical benefits that come with your plan, please call Member Services at 1-800-316-CARE (2273), 7 a.m. to 8 p.m., Central Time, seven days a week. TTY users should call 1-800-848-0298.

Windsor Medicare Extra is a product of Windsor Health Plan, Inc., a Medicare Advantage organization with a Medicare contract.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2011.

You must continue to pay your Medicare Part B premium.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. for more information about this Extra Help, contact your local Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778. Or you can call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To request materials in alternative formats (i.e. large print or audio compact disk) or other languages, please contact our Customer Service department at 1-800-316-2273 (TTY: 1-866-460-7617) 7 a.m. - 8 p.m. Central Time, seven days a week.

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Windsor Medicare Extra will be responsible for the costs.

Windsor Medicare Extra Comp Plus Plan (HMO SNP) is available to all persons with Medicare who also receive Medical Assistance from their state Medicaid/Tenncare programs. Premiums, co-pay, co-insurance and deductible amounts are based on the level of Extra Help you receive. You should check with your state to confirm your eligibility level, or contact the plan for further details.

Windsor Medicare Extra Diabetes Plan (HMO SNP) is available to all persons with Medicare who have been diagnosed with diabetes mellitus by a physician. Physician documentation of your condition to demonstrate your eligibility for the plan will be required to complete your enrollment in the plan.

Windsor Medicare Extra Fusion Plan (HMO SNP) is available to all persons with Medicare who have been diagnosed with the following chronic or disabling conditions: bipolar disorder, major depression, paranoid disorder, schizophrenia, schizoaffective disorder. Physician documentation of your condition to demonstrate your eligibility for the plan will be required to complete your enrollment in the plan.