Today’s Options^® PPO Disclaimers

Today’s Options^® PPO is a Medicare-approved Medicare Advantage plan offered through the following organizations that contract with the Federal government: American Progressive Life & Health Insurance Company of New York and Pyramid Life Insurance Company, members of the Universal American family of companies.

Our plan is available to anyone enrolled in Part A and Part B of Medicare through age or disability who continues to pay any applicable Medicare premiums and lives in the plans service area. You must continue to pay your Medicare Part B premium. The Pyramid Life Insurance Company and American Progressive Life & Health Insurance Company and its agents are not connected in any way with the federal or state government or Medicare.

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 Today’s Options PPO will end, and you will need to enroll in another Medicare Advantage Plan to continue your coverage. All of the benefits and rules of Today’s Options PPO would continue until the effective date your membership in Today’s Options PPO ends. You also would continue to receive your prescription drugs in the usual way through Today’s Options PPO network pharmacies.

If Today’s Options PPO leaves the Medicare program or your service area; you would need to select another plan. Your choices would include joining another Medicare Advantage 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 Today’s Options PPO 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

Low Income Subsidy (LIS)

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy five (75) 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 or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Exceptions, Appeals and Grievances

An exception is a type of initial determination (also called a coverage determination) involving a Part D drug.  A plan member or their doctor may ask us to make an exception to our Part D coverage rules in a number of situations.

Today’s Options PPO allows members to submit complaints to the Plan which may become either an Appeal or Grievance.

Enrollment Limitations

Members may enroll only during specific times of the year. Contact a Customer Service Representative at 1-866-249-8668 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-777-9083) every day, to obtain more information.