2021 Simplete Riverside Medicare Guidebook

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2021 Simplete Medicare Advantage

BENEFITS GUIDE Plus Prescription Drug Coverage

ILLINOIS

INDIANA

Iroquois Kankakee Livingston Grundy

Benton Newton

SIMPLETE™ PLAN OPTIONS Simplete Riverside 1 (HMO) Simplete Riverside 2 (HMO) Simplete Riverside 3 (HMO-POS)

How to Enroll Online Visit simplete.org to get started.

By Phone Call (877) 642-4753 (TTY 711), daily from 8 a.m. to 8 p.m. local time.

Voicemail is used on holidays and weekends from April 1 to September 30.

By Mail Fill out the enrollment form in the back of this book and mail to: 3310 Fields South Dr., Champaign, IL 61822.

Broker If you attend a seminar, the person presenting can schedule an appointment to help you enroll.

TABLE OF CONTENTS Meet Simplete Simplete at a Glance In-Network Providers More Complete Benefits Simplete Drug Coverage Pharmacy Partnerships Care Coordination and Health Coaching Team Perks, Programs and More Coverage While You Travel Summary of Benefits How to Enroll in Simplete Formulary

Meet Simplete.

The simpler way to complete Medicare coverage.

Medicare can be complex. That’s why we set out to create something simpler.

We listened to feedback from patients and local healthcare providers who know best how to serve the needs of the community.

Through their guidance and partnership, we’ve been able to achieve a common goal: Medicare plans that deliver an easier, more affordable healthcare experience.

Save with Simplete.

Paying more for less coverage? That was the old way. Now there’s a new way.

Simplete delivers lower costs and more perks thanks to our strong provider network.

Simplete isn’t just another Medicare plan – it’s a whole new approach to healthcare.

By creating better collaboration between providers and the insurance company, we’ve been able to reduce the red tape, lower costs and provide more benefits. Now you can enjoy a simpler, more complete healthcare experience.

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Simplete at a Glance Three Simplete Plans To keep things simple, we’ve focused on three plans, each one delivering complete coverage but with a different degree of flexibility.

All Plans Include: • Prescription drug coverage.

• Access to leading local providers at lower costs.

• Hearing.

• Dental.

• Vision.

• Urgent and emergency care coverage worldwide.

COSTS AT A GLANCE

Premium

Primary Care Visit

Specialist Visit

Yearly Limit

SIMPLETE RIVERSIDE 1 (HMO)

SIMPLETE RIVERSIDE 2 (HMO)

SIMPLETE RIVERSIDE 3 (HMO-POS)

$0 a month (Must See Tier 1 Providers)

$50 a month (Can See Tier 1 & Tier 2 Providers)

$70 a month (Can See a Provider of Your Choice)

$5

Tier 1: $5 Tier 2: $25

Tier 1: $5 Tier 2: $25 OON: $50

$10

Tier 1: $10 Tier 2: $40

Tier 1: $10 Tier 2: $40 OON: $60

$4,950

Tier 1: $4,950 Tier 2: $4,950 OON: $6,700

$4,750

Comparing Simplete Plans With Simplete, healthcare providers are grouped into two tiers (Tier 1 and Tier 2).

These tiers determine how much you’ll pay when you receive services from that provider.

For more information about provider tiers, refer to the In-Network Providers section of this guide. For a closer look at Simplete plans and their benefits, please refer to the Summary of Benefits included in this guide.

Not sure which Simplete plan is right for you?

We’re here to help. Call us at (877) 642-4753 (TTY 711) or contact us online at simplete.org with your questions. We’ll help you find the plan and providers that make the most sense for your needs.

Pay for what you actually use.

Wasting money on coverage you don’t use?

That was the old way. Now there’s a new way.

Simplete offers flexible coverage options and gives you perks you can use every day.

Simple and Complete Frustrated by the confusing layers of Medicare benefits? That was the old way. Now there’s a new way. Simplete offers complete care and added perks in one simple package.

Medicare Advantage vs. Medicare Supplement All the different types of Medicare plans can be overwhelming, which is why we decided to offer only Medicare Advantage plans with Simplete.

Medicare Advantage allows us to streamline the healthcare services you need most (doctor appointments, hospital visits, prescriptions, hearing, dental and vision benefits) all in one plan. However, Medicare Advantage may not be for everyone. Here is a look at the main differences between Medicare Supplement and Medicare Advantage:

MEDICARE SUPPLEMENT

MEDICARE ADVANTAGE

How it Works

Pays for Medicare-eligible services after Original Medicare (Parts A and B) pays its share.

Pays for your medical expenses in place of Original Medicare.

Perks

No included perks.

Adds perks, like dental, vision, hearing and wellness.

Drug Coverage

Still need to get separate prescription coverage (Part D).

Covers services you need (after Parts A and B), including prescription coverage (Part D).

Monthly Premium

The monthly premiums are higher, but you’ll likely not pay out-of-pocket costs.

Medicare Advantage has lower monthly premiums.

Some Simplete plans have $0 premiums.

Age and Tobacco Use

Age and tobacco use will affect monthly premium.

Age and tobacco use won’t affect monthly premium.

Doctors

Flexibility to see any doctor who accepts Original Medicare.

Must choose in-network primary care providers for care or the ability to see OON providers at an additional cost.

All members enrolling in Medicare Advantage must start with enrolling in Original Medicare, Parts A (hospital) and B (medical/outpatient care).

To be eligible for Simplete Medicare Advantage, you must live in the service area, and must continue to pay your Medicare Part B premium if not otherwise paid for by Social Security or another third party.

In-Network Providers The Simplete network is made of leading community providers you know and trust from Riverside Healthcare. By partnering with Riverside Healthcare, we help reduce healthcare costs and put more control back into the hands of doctors.

Simplete Provider Promise If there is no in-network provider that can treat your condition, Simplete will work to find a provider that can – and cover it at in-network cost.

Tier 1 vs. Tier 2 Providers Simplete providers are divided into two groups: Tier 1 and Tier 2. The main difference between the two is your out-of-pocket cost.

Tier 1 providers are preferred Simplete providers and will always be the lowest cost option for you.

Tier 2 providers are participating Simplete providers, but you may have to pay more for services than with Tier 1 providers.

TIER 1

Visit simplete.org for full provider list.

Riverside Medical Center

• Immediate

*at all RMC Facilities

• Cardiology

• Rheumatology

• Emergency

• Family

• Urology

Physicians Medical Group • Associates of Integrated Medicine Hospitalists • Central Illinois Radiological Associates • IntraNerve • Metro Infectious Disease Consultants • North American Partners in Anesthesia • University Pathologists • Vision Radiology

Bloomington-Normal • Carle

Bromenn Medicare Center & Physicians

Bourbonnais • 2HT

Kidney Care, Ltd. • Riverside Ambulatory Surgery Center • Riverside Medical Group • Internal Medicine • Family Medicine • Endocrinology • Gynecology • Medical Oncology • Medical Hematology • Orthopedic Surgery • Physical Medicine and Rehabilitation • Plastic Surgery • Podiatry • Radiation Oncology • Riverside Sleep Disorder Insitute • Allergy & Asthma Associates • Davita • Digestive Disease Consultants • Fisher Swale Nicholson Eye Center • Pinnacle Dermatology

Bradley • Riverside

Medical Group Immediate Care • Workforce Health • Chiropractic Associates Of Kankakee Inc • Meijer

Champaign-Urbana • Carle

Foundation Hospital • Carle Physician Group

Coal City • Riverside

Medical Group

Care

Medicine • Gynecology • General Surgery • Pulmonology • Rheumatology

• Pulmonology

• Wound

Center B Pigato MD Ltd • Miller Health Center • Soren D. Lang, MD • Joseph

Danville

Manteno

• Carle

• Riverside

Physician Group

Frankfort • Riverside

Medical Group • Audiology • Cardiology • General Surgery • Internal Medicine • Family Medicine • Pulmonology • Medical Oncology • Medical Hematology • Neurosurgery • Otolaryngology • Orthopedic Surgery • Pulmonology • Psychiatry • Rheumatology

Kankakee • Riverside

Medical Center • Riverside Medical Group • Audiology • Breast Cancer Navigation • Cardiothoracic & Vascular Surgery • Cardiology • Ear, Nose and Throat (Otolaryngology) • Family Medicine • General Surgery • Geriatric Medicine • Gynecology • Internal Medicine • Immediate Care • Interventional Cardiology • Neurology • Neurosurgery • Physical Medicine & Rehabilitation • Presence St. Mary’s Dialysis Center • Psychiatry

Medical Group

• Gynecology • Family

Medicine

• Cardiology

Momence • Riverside

Medical Group Medicine • Gynecology • Family

Monee • Riverside

Medical Group Care

• Immediate

St. Anne • Riverside

Medical Group

• Pulmonology

Watseka • Riverside

Medical Group • Cardiology • Family Medicine • General Surgery • Gynecology • Immediate Care • Interventional Cardiology • Medical Hematology • Medical Oncology • Neurosurgery • Neurology • Orthopedic Surgery • Pulmonology • Rheumatology • Digestive Disease Consultants

Wilmington • Riverside

Medical Group

• Cardiology • Internal • Family

Medicine Medicine

TIER 2

Visit simplete.org for full provider list.

Bloomington-Normal • Carle

BroMenn Medical Center & Physicians • OSF Medical Group • OSF St. Joseph Medical Center

Bradley

• Alliance

Health • Cardiac Surgery Associates • Northwestern Medicine Regional Medical Group • Presence Medical Group • Rezin Orthopedics & Sports Medicine, SC

Surgical Institute • Orthopedic Associates

Manteno

Champaign-Urbana

Morris

• Christie

• Morris

• Oak

Clinic • OSF Heart of Mary Medical Center

Channahon • Athletico • Morris

Physical Therapy Hospital & Physicians

Coal City • Athletico

Physical Therapy Physicians of Coal City • Lighthouse Counseling, PC • Presence Medical Group • Family

Danville • Carle

Physician Group Clinic • Danville PolyClinic • Hoopeston Community Memorial Hospital – Hoopeston • OSF Sacred Heart Medical Center • Christie

DeKalb/Rockford Area • Kishwaukee

Community Hospital & Physicians Medical Group • OSF Saint Anthony Medical Center • Rockford Memorial Hospital & Physicians • OSF

Frankfort • Bielinski

Dermatology Group • Orthopedic Associates

Joliet

• Prairie

Rock Foot & Ankle

Hospital & Physicians Medical, Inc. • Crossroads Counseling • Northwestern Medicine Regional Medical Group • Institute for Personal • Liberty Medical Center • Rezin Orthopedics • AGHA

New Lenox • Affiliated

Oncologists LLC Associates of WI • Digestive Disease Consultants • Northwestern Medicine Regional Medical Group • Presence Medical Group • Dermatology

Peoria • OSF

Medical Group • OSF St. Francis Medical Center • UnityPoint - Pekin • UnityPoint - Methodist • UnityPoint - Proctor

Pontiac • OSF • OSF

Multi-Specialty Group Saint James Hospital

Watseka • Gailey

Eye Clinic • Iroquois Memorial Hospital • IMH Multispecialty Physicians • Iroquois Memorial Hospital Specialty Clinic • Presence Medical Group

Filling the Gaps Medicare not including dental, hearing or vision? That was the old way. Now there’s a new way. Simplete includes these benefits and more with all Medicare Advantage plans.

More Complete Benefits Vision Coverage Get access to vision services beyond what Original Medicare covers, including a routine vision exam with an in-network provider.

Through TruHearing®, you can get one routine hearing exam for a $45 copay and lowered rates on up to two TruHearing hearing aids per year when you see a TruHearing provider.

Comprehensive Dental Simplete members get $200 – $225 each year for services Original Medicare doesn’t cover. Your dentist can submit a claim for you directly to us (Simplete) using the claims information on the back of your member ID card.

Acupuncture If you have a qualifying diagnosis, your Simplete coverage includes acupuncture treatments. Qualifying diagnoses include headache, neck pain and lower back pain.

Simplete plans include all Medicarecovered dental services but also offer non-Medicare-covered dental services as well. These additional benefits include but are not limited to:

Coverage Everywhere You Go

• Oral exams.

• Anytime Nurse Line.

• Cleanings.

Coverage When Traveling the World:

• X-rays.

• Urgent and emergency care worldwide.

• Fluoride treatments.

• Fillings.

• Dentures.

• Denture adjustments and repairs.

• Crowns.

• Treatments for gum disease.

• Bridge work.

• Root canals and extractions.

Hearing Benefit

Coverage Without Leaving the Couch: • Virtual health coverage.

• No matter what happens or what urgent care/emergency room you visit, it won’t cost more than it would at home. Additional medical and non-medical benefits provided by Assist America®.

Simplete Drug Coverage Many Medicare options don’t include prescription drug coverage (also known as Part D). It must be purchased and managed separately.

Also, if you forget to enroll in Part D, you may receive a late penalty.

With Simplete, Part D (prescription coverage) is included automatically.

Plus, there are no pharmacy deductibles, and drug costs are kept low thanks to our network of pharmacy partners. Less cost. Less hassle.

Understanding Drug Tiers Covered drugs are categorized by tiers. The main difference between tiers is your out-of-pocket cost. The most commonly used drugs are considered “Tier 1� and will be more affordable. The Simplete drug tiers are as follows:

Tier 1 - Preferred Generic Tier 2 - Generic Tier 3 - Preferred Brand Tier 4 - Non-Preferred Drug Tier 5 - Specialty Tier The cost of a drug will depend on the tier it falls into and the pharmacy you use. Refer to the Summary of Benefits for more information about specific Simplete plan benefits and cost information.

Prescriptions for Less Paying for a separate prescription plan?

That was the old way. Now there’s a new way.

Simplete includes prescription coverage – and for less, thanks to our pharmacy partnerships.

Pharmacy Partnerships Simplete streamlines relationships with pharmacies to help lower costs for you by having a pharmacy network.

You must use an in-network pharmacy to get covered drugs unless it’s an emergency. For a list of in-network pharmacies, view our pharmacy directory at simplete.org, or request a copy using the card in the back of this guide.

Save with Simplete.

Every opportunity to save money is important, especially when it comes to prescriptions. That’s why Simplete offers special savings programs to help you lower the cost of your medications. Here are some of the ways you can save with Simplete: No Pharmacy Deductible – All Part D plans begin with full benefits immediately. There is no pharmacy deductible you have to meet first.

90 Day Supply Savings – Limit your trips to the pharmacy with two convenient options.

With our mail-order benefit, you can get a 90-day supply of your drugs delivered directly to you for two copays. If you prefer to get your drugs at a retail pharmacy, you can visit any in-network pharmacy and get a 90-day supply for three copays.

Medication Therapy Management – If you take multiple medications, our complimentary Medication Management Service helps you use them safely and effectively.

Financial Assistance – You may be eligible to receive financial assistance for your prescriptions through the Extra Help program. To see if you qualify, call one of the following: • (800) MEDICARE (800-633-4227), 24 hours a day, seven days a week (TTY 877-486-2048).

• The Social Security Administration at (800) 772-1213, 7 a.m. to 7 p.m., Monday through Friday (TTY 800-325-0778).

• The Medicare office for your state.

Drugs We Cover All the drugs covered by Simplete plans are included in what we call a formulary.

The Simplete formulary packet is included with this booklet. You can also find the formulary online to search for your prescription and estimate your costs for the year at simplete.org.

COSTS IN THE INITIAL COVERAGE PERIOD 30-DAY DRUG COST

BY TIER

Simplete Riverside 1 Simplete Riverside 2 Simplete Riverside 3

Tier 1 - $2 Tier 2 - $15 Tier 3 - $47 Tier 4 - 50% Tier 5 - 33%

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Caring About You Feeling like just a number in a system? That was the old way. Now there’s a new way. Simplete includes wellness perks and a care coordination team to help you live a healthy lifestyle.

Care Coordination and Health Coaching Team What Truly Sets Simplete Apart It’s time to focus more on preventing illness and injury. With our care coordination and health coaching team, you receive personalized care that guides you towards a healthy lifestyle.

This includes: • Setting and reaching health and wellness goals.

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• Understanding and managing health issues, like diabetes and asthma.

• Coordinating care for complicated health conditions.

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• Helping prevent illness and hospital stays.

• Finding helpful resources.

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How It Works Think of our care coordination and health coaching team as an extension of your doctor’s office. We have a dedicated team of social workers, dieticians, pharmacists and health coaches – all working together on your behalf. Here are some of the ways we help: • After being diagnosed with diabetes, it can be very confusing to manage all the new medications, monitoring blood sugar levels and changing diet. We help remove confusion and keep things on track.

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• After hip replacement surgery, there will be medications to manage and physical therapy to attend. The care team can help arrange these services before you even leave the hospital.

• Nurse practitioners can provide in-home visits to ensure you have a safe living environment, then connect you with community resources to help improve your environment as needed.

• At any time, our team can help you with making healthy lifestyle changes, including eating better, working out and more.

Turning Healthy Choices into Rewards Paying for coverage you never use?

That was the old way. Now there’s a new way. Simplete includes healthy living perks you can use every day. We want you to live a happy, healthy lifestyle, so we offer plenty of perks and incentive programs to help.

Perks, Programs and More Preventive Care At no additional cost to you, Simplete covers many preventive services, including: • Annual Wellness visits.

• Routine cancer screenings (including mammograms and colonoscopies).

• Cardiovascular disease risk-reduction visits.

• Flu shots.

• Bone mass measurements.

• Depression, diabetes and HIV screenings.

• Hepatitis B and pneumococcal shots.

• Medical nutrition therapy.

• Obesity screening and therapy.

You can also get care for common conditions like allergies, cold, flu and pink eye from anywhere you have phone or internet connection in the U.S. Whether at home or traveling, you can talk to a board certified doctor or counselor by phone or secure video through the Hally™ app or hally.com at any time of the day, any day of the year.

Be Fit With our Be Fit program, you get paid back up to $360 per year for a gym membership or fitness class fees. If your fees are more than $360 per year, you pay the difference.

• Screening and counseling to reduce alcohol misuse.

Note: Be Fit doesn’t cover services that require additional fees, like personal trainers or personal equipment. It applies to only standard fitness class and gym membership fees at non-residential, commercial or community facilities.

• Screening for sexually transmitted infections (STIs) and counseling to prevent STIs.

Wellness Rewards

• Counseling to stop smoking or tobacco use.

• “Welcome to Medicare” preventive visit (one-time).

Anytime Nurse Line Get 24/7 answers to your health questions, like whether you need to set up an appointment or see a doctor right away.

Virtual Health Coverage Get care when and where you need it with virtual health coverage. If you need to interact with your primary care provider (PCP) or specialist over the phone or online, you’re covered through the telehealth benefit. You don’t even need to leave the comfort of your home.

Take steps toward better health while working your way toward a $50 gift card. Have a yearly wellness visit or physical, plus complete two other activities outlined at simplete.org/perks to qualify for your $50 gift card.

HallyTM App Manage your health plan and get the care you need anytime, anywhere.

• All your account activities in one place.

• Virtual ID card access.

Coverage While You Travel

Hally is your ally in all things health.

From Suitcase to Worst Case You’ve worked hard your whole life, now it’s time to travel. You deserve a plan that keeps up with your travel plans. Here is how Simplete gives you peace of mind while on vacation.

Visit the Apple® App Store® or Google Play® to download the Hally™ app.

Access to Worldwide Emergency and Urgent Care

App Store is a service mark of Apple Inc., registered in the U.S. and other countries.

Google Play and the Google Play logo are trademarks of Google LLC.

If you’re having a medical emergency, you shouldn’t have to worry about your coverage.

Simplete plans provide access to virtual health coverage in the United States and an Anytime Nurse Line worldwide so you can get care and answers to health questions whether you’re at home or away.

• Search functions.

• Quick access to virtual visits.

• Doctor match and cost estimates.

Reminder: Get your yearly flu shot.

Quit for Life® Quitting tobacco is one of the biggest positive impacts you can make on your health. That’s why we offer the Quit for Life program – the nation’s leading tobacco-cessation program.

This service helps you quit for good by using: • One-on-one coaching from a quit coach.

• A personalized quit plan.

• Helpful tools, like Text2Quit™.

• Web Coach®, an online learning and support community.

Help prevent getting or spreading the flu with your flu shot. The viruses that cause the flu can change yearly, so it’s important to get your shot every year. You can get your shot for no extra cost at any in-network provider or pharmacy that offers it. You may have an office visit copay if you get it at the doctor’s office.

Assist America® When you travel 100 miles or more from home, Simplete members have access to Assist America®*, a global emergency service that’s ready to help if you have an immediate health need. Assist America can connect you to prompt, reliable medical attention, as well as some non-medical services, as needed. Here are just some of the services that are included: • Prescription assistance if you need medication or left your prescription behind.

• Medical referrals.

• Emergency medical evacuation.

• Help returning home if you need medical care.

• Lost luggage assistance.

• Interpreter and legal referrals. *Members may have additional costs related to travel services.

All Assist America benefits apply on all of our Medicare Advantage plans, but when you’re out of network, our HMO plans cover only emergency and urgent care.

Assist America will not pay you back for ambulance and other services you arrange on your own. In a life-threatening emergency, always call the ambulance right away. There is no added cost for the service itself, but there could still be a cost with any medical care.

Other conditions and exclusions may apply.

Travel Coverage FAQs What if something happens and I get admitted to the hospital or have to have surgery while traveling?

• If it’s an urgent or emergent situation, we’ll still cover your claims at the in-network level anywhere you go.

• Once you’re stabilized, we ask that you return to in-network providers to ensure we can coordinate your recovery.

What happens if I need routine care (like diabetes blood checks) while staying out-ofnetwork for an extended period of time?

• If you have an HMO plan, you won’t have coverage.

• If you have a POS plan, you can use your out-of-network (OON) benefits for routine care. If you know you’ll spend extended periods of time out of network, we recommend a POS plan.

What if I need to see a specialist while out of network?

• If you have a POS plan, you can use your out-of-network benefits to see an out-of-network specialist or provider without a preauthorization.

• If you have an HMO plan, you’ll need to receive a preauthorization from Simplete for your claims to be covered.

• If the specialist is in the Simplete network, we don’t require a referral or preauthorization to go to that provider. The specialist may request that you get a referral from your primary care provider (PCP), but that’s the specialist’s policy, not a Simplete policy.

Coverage on the Go Stressing about health coverage when you travel? That was the old way. Now there’s a new way.

Simplete includes global coverage for emergency and urgent care, plus additional travel assistance through Assist America®.

Summary of Benefits This section gives you a summary of what our plans cover and what you pay. It doesn’t list every service we cover or every limitation or exclusion. For a complete list of covered services, call us and ask for the Evidence of Coverage (EOC).

This information is available in other formats, such as braille and large print. For more information, call (877) 634-3390 (TTY 711), daily from 8 a.m. to 8 p.m. local time. Voicemail is used on holidays and weekends from April 1 to September 30.

How to Enroll in Simplete Timelines and Requirements The Centers for Medicare & Medicaid Services (CMS) sets certain times during the year when people can enroll in a Medicare Advantage or prescription drug plan.

Annual Enrollment Period From October 15 to December 7, you can enroll in Medicare Advantage or a standalone prescription drug plan, or you can switch plans. If you enroll during this period, your coverage begins January 1 of the following year.

Initial Enrollment Period You have a seven-month initial enrollment period to enroll in Original Medicare, Medicare Advantage or a prescription drug plan. It starts three months before the month you turn 65, includes the month of your 65th birthday and ends three months after the month you turn 65.

Open Enrollment Period From January 1 to March 31, you can switch to Original Medicare and/or join a stand-alone prescription drug plan. If you’re currently in a Medicare Advantage plan, you can switch to another Medicare Advantage plan.

Special Enrollment Period You can enroll in a new plan or change your plan in certain situations. Here are some examples: • Permanent address change.

• Loss of coverage due to employment change.

• Becoming eligible for a low-income subsidy.

Contact us for other situations that qualify.

Who’s eligible for our plans?

• You must have Medicare Parts A and B and live in the service area.

• If you enroll one to three months before your 65th birthday, your coverage begins the first day of the month you turn 65.

• You must continue to pay your Medicare Part B premium if not otherwise paid for

by Social Security or another third party.

• If you enroll during your birth month, your coverage begins the first day of the following month.

Enrollment in the plan will automatically disenroll you from any other Medicare Advantage plan. Enrollment in the plan won’t automatically disenroll you from a Medicare Supplement plan. You must contact that plan to disenroll.

• If you enroll one to three months after the month you turn 65, your coverage begins the first day of the month after you enroll.

Enrollment Process Enrolling Online Visit simplete.org to get started.

Enrolling by Phone Call (877) 642-4753 (TTY 711), daily from 8 a.m. to 8 p.m. local time. Voicemail is used on holidays and weekends from April 1 to September 30.

Enrolling by Mail Fill out and mail us the enrollment form in the back of this book.

You can also download it from simplete.org.

Simplete Application Processing Center 3310 Fields South Dr. Champaign, IL 61822 Broker If you attend a seminar, the person presenting can schedule an appointment to help you enroll.

After You Enroll If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, your coverage will begin January 1, 2021. In the meantime, we’ll help you get settled with the following: • Member materials, which we’ll mail to you.

• Member ID card to use at the doctor, hospital and pharmacy, instead of your red, white and blue Medicare card.

Late Enrollment Penalty If you don’t enroll in a prescription drug (Part D) plan when you’re first eligible, you may have to pay a penalty for enrolling later. That penalty will increase for every month you didn’t have prescription coverage.

Plan Protections If you ever have an issue with your plan, Simplete makes it easy to reach out. If you have any grievances or want to appeal a decision, just give us a call and someone will help you with the filing process Grievance File this complaint about the plan if you feel you’ve had poor quality of care or customer service. Call us to get started within 60 days or as soon as possible.

Appeal File this to disagree with the plan’s decision to deny a request to cover healthcare services or pay for services received.

File in writing within 60 days or as soon as possible.

See all your benefits in one place.

See your complete coverage details anytime at simplete.org. Our secure member website stores important plan information in one easy place. You can download the member app at the App Store or Google Play.

2021 Star Ratings Health Alliance Medicare - H1463 2021 Medicare Star Ratings Every year, Medicare evaluates plans based on a 5-star rating system. Medicare Star Ratings help you know how good a job our plan is doing. You can use these Star Ratings to compare our plan's performance to other plans. The two main types of Star Ratings are: 1. An Overall Star Rating that combines all of our plan's scores.

2. Summary Star Ratings that focus on our medical or our prescription drug services.

Some of the areas Medicare reviews for these ratings include: How our members rate our plan's services and care; How well our doctors detect illnesses and keep members healthy; How well our plan helps our members use recommended and safe prescription medications.

For 2021, Health Alliance Medicare received the following Overall Star Rating from Medicare.

4 Stars We received the following Summary Star Ratings for Health Alliance Medicare's health/drug plan services: Health Plan Services:

4 Stars

Drug Plan Services:

3.5 Stars

The number of stars shows how well our plan performs.

5 stars - excellent 4 stars - above average 3 stars - average 2 stars - below average 1 star - poor Learn more about our plan and how we are different from other plans at www.medicare.gov.

You may also contact us 7 days a week from 8:00 a.m. to 8:00 p.m. Central time at 877-642-4753 (toll-free) or 711 (TTY), from October 1 to March 31.

Our hours of operation from April 1 to September 30 are Monday through Friday from 8:00 a.m. to 8:00 p.m. Central time.

Current members please call 877-933-8481 (toll-free) or 711 (TTY).

Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next.

Simplete is powered by Health Alliance Medicare - a Medicare Advantage Organization with a Medicare contract. Enrollment in Simplete depends on contract renewal.

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Simplete is powered by Health Alliance Medicare - a Medicare Advantage Organization with a Medicare contract.

Enrollment in Simplete depends on contract renewal.

Health Alliance Medicare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Spanish: ATENCIÓN: Si habla español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. Llame 1-800-965-4022 (TTY: 711). Chinese: 注意：如 果你講中文，語言協助服務，免費的，都可以給你。呼叫 1-800-965-4022 (TTY: 711).

Other pharmacies/physicians/providers are available in our network. Out-of-network/non-contracted providers are under no obligation to treat Simplete members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Every year, Medicare Evaluates plans based on a 5-star rating system.

ILLINOIS: IROQUOIS, KANKAKEE, LIVINGSTON, GRUNDY INDIANA: BENTON, NEWTON

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