PrescribaRx Disclaimers

PrescribaRx^SM PDP is a Medicare-approved Part D sponsor offered by the following organizations that contract with the Federal government: American Progressive Life & Health Insurance Company of New York and Pennsylvania Life Insurance Company, members of the Universal American family of companies.

Potential for Contract Termination

In the unlikely event your Plan Sponsor leaves the Medicare program, or no longer offers prescription drug coverage in the service area where you live, we will notify you in writing.

If this happens, your membership in PrescribaRx will end, and you will need to enroll in another Medicare Prescription Drug Plan to continue your prescription drug coverage. All of the benefits and rules of PrescribaRx would continue until the effective date your membership in PrescribaRx ends. You also would continue to receive your prescription drugs in the usual way through PrescribaRx’s network pharmacies.

If PrescribaRx leaves the Medicare program or your service area, you would need to select another plan. Your choices would include joining another Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage (MA-PD), if these plans are available in your area and are accepting new members. As soon as PrescribaRx has notified you in writing that we are leaving the Medicare program or the area where you live, you may enroll in another plan.

The Plan Sponsor is contracted with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract is subject to renewal each year. However, the Plan Sponsor or CMS can decide to end the contract at any time. You will generally be notified 90 days in advance if this situation occurs. However, your advance notice may be as little as 30 days or fewer if CMS must end the contract in the middle of the year.

Enrollment Limitations

Members may enroll only during specific times of the year, please contact Customer Service at 1-800-818-0007 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-777-9083) every day.

Availability of Medicare Subsidy Information

You may be able to receive Extra Help for your prescription drugs premiums and costs. People with Medicare interested in qualifying for Extra Help with Medicare Prescription Drug Plan costs should call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week), or
• The Social Security Administration at: 1-800-772-1213 between 7 a.m. and 7 p.m., Monday thru Friday. TTY/TDD users should call 1-800-325-0778 , or
• Your State Medicaid Office

Low Income Subsidy Premium Disclaimer

If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. When you join PrescribaRx, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you aren’t getting any extra help, you can see if you qualify by calling:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week), or
• The Social Security Administration at: 1-800-772-1213 between 7 a.m. and 7 p.m., Monday thru Friday. TTY/TDD users should call 1-800-325-0778 , or
• Your State Medicaid Office