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Today's Options PFFS Logo
Need help? Call 1-866-568-8921
(TTY for hearing impaired 711)
8:00 a.m. to 8:00 p.m. in your local time zone, 7 days a week
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2013 Today's Options® PFFS

  • Collpase Menu
    • 2013 plan overview
    • Plan benefits
    • Plan information and forms
      • Member FAQ
      • Low income subsidy (Extra Help)
      • Understanding your coverage
      • Plan documents
      • Additional forms and documents
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      • Enroll now
      • Do I qualify?
    • Learn about formulary and prior authorizations
      • Formulary information
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      • Restrictions to the formulary
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    • For providers and pharmacies

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Additional Forms and Documents

Click on the links below to find the correct form you need.

  • Appointment of Representative Form
  • Medicare Five-Star Quality Ratings System

To view forms for Medicare Advantage plans with prescription drug coverage (MA-PD), please click here.

Appointment of Representative Form

Our members can appoint a representative to act on their behalf. To do so, we must have written authorization signed by both the representative and the member.

A representative who is appointed by the court or who is acting in accordance with state law may also file a request on your behalf after sending us the legal representative document. You will not need to complete an Appointment of Representative Form if you provide another legal representation document with your request.

Download an Appointment of Representative form (PDF). Once the form is filled out in its entirety, fax it to us at 1-877-907-2982.

Medicare Five-Star Quality Rating System

The Medicare Program rates how well Today's Options PFFS performs in different categories (for example, detecting and preventing illness, rating from patients, patient safety and customer service). The information provided below is a summary rating of our plan's overall performance. You also may visit www.medicare.gov for more information (by clicking on this link you are leaving our website).

  • H3333: Today's Options PFFS Medicare Plan Ratings (PDF)
  • H5421: Today's Options PFFS Medicare Plan Ratings (PDF)
Disclaimer Information:

Medicare Complaint Form. For more information, visit Medicare.gov or Medicare's Ombudsman. (By clicking on these links you will be leaving our website).

Today's Options® PFFS is a Health plan with a Medicare contract.

A Private Fee-for-Service plan is not a Medicare supplement plan. Providers who do not contract with our plan are not required to see you except in an emergency.

You must continue to pay your Medicare Part B premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
Benefits, formulary, pharmacy network, premium and/or copayment/co-insurance may change on January 1 of each year.

Plan performance Star Ratings are assessed each year and may change from one year to the next.

Medicare beneficiaries may also enroll in Today's Options® PFFS through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.Medicare.gov (by clicking on this link you will be leaving our website).

We also list pharmacies that are in our network but are outside Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Oklahoma, Texas, Vermont, Washington, and Wisconsin. Please contact Today's Options® PFFS at 1-866-568-8921, 8:00 a.m. to 8:00 p.m. in your local time zone, 7 days a week, for additional information.

This information is available for free in other languages. Please contact our customer service number at 1-866-568-8921, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 711) 7 days a week. This document may be available in other formats such as Braille, large print or other alternate formats. This document may be available in a non-English language. For additional information, call customer service at the phone number listed above.

Esta información está disponible sin cargo en otros idiomas. Para obtener más información, comuníquese con el Servicio de Atención al Cliente al número 1-866-568-8921, de 8:00 a.m. a 8:00 p.m. en su zona horaria local (los usuarios de TTY deben llamar al 711) los 7 días de la semana.

Este documento puede estar disponible en otros formatos, como Braille, letra grande o otros formatos alternativos. Este documento puede ser disponible en un idioma no inglés. Para obtener más información, llame al servicio al cliente en el número de teléfono que aparece arriba.

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