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2022 Simplete® Medicare Advantage
BENEFITS GUIDE Plus Prescription Drug Coverage
ILLINOIS
INDIANA
Champaign McLean Piatt Vermilion Woodford
Fountain Vermillion Warren
SIMPLETE® PLAN OPTIONS Simplete 1 (HMO) Simplete 2 (HMO) Simplete 3 (HMO-POS)
How to Enroll Online Visit simplete.org/medicare to get started. By Phone 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. 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.
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: a Medicare plan that deliver an easier, more affordable healthcare experience.
TABLE OF CONTENTS Simplete at a Glance In-Network Providers More Complete Benefits Simplete Drug Coverage Pharmacy Partnerships Care Coordination Perks, Programs and More Coverage While You Travel Travel Coverage FAQs Summary of Benefits How to Enroll in Simplete
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. Find an overview of your plan options and benefits made for you in our 2022 Key Medicare Advantage Benefits guide.
All Plans Include: • Plans as low as $0 a month. •
Dental, vision and hearing coverage.
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Virtual health coverage.
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Fitness and healthy lifestyle benefit.
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$0 pharmacy deductible and $2 Tier 1 generics.
COSTS AT A GLANCE SIMPLETE 1 (HMO)
SIMPLETE 2 (HMO)
SIMPLETE 3 (HMO-POS)
Premium
$0 a month (Must see Tier 1 providers.)
$28 a month (Can see Tier 1 and Tier 2 providers.)
$48 a month (Can see a provider of your choice.)
Primary Care Visit
$0
Tier 1: $5 Tier 2: $20
Tier 1: $5 Tier 2: $25 OON: $50
Specialist Visit
$25
Tier 1: $25 Tier 2: $40
Tier 1: $25 Tier 2: $40 OON: $50
Yearly Limit
$4,000
$4,950
Tier 1: $4,950 Tier 2:$4,950 OON: $6,700
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) 634-3390 (TTY 711) or contact us online at simplete.org/medicare with your questions. We’ll help you find the plan and providers that make the most sense for your needs. OON = out-of-network care.
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 Carle BroMenn Medical Center, Carle Eureka Hospital, Carle Foundation Hospital, Christie Clinic and Kirby Medical Center. By partnering with these specific providers, we help reduce healthcare costs and put more control back into the hands of doctors.
Tier 1 vs. Tier 2 Providers
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 the in-network cost.
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 their services than with Tier 1 providers.
TIER 1
Visit simplete.org/medicare for the full provider list.
Bloomington-Normal • Carle BroMenn Medical Center •
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Carle Bloomington on Eastland Carle Bloomington on Hershey
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Cura Medical Group r. Laura C. Randolph & D Chad Tattini, MD
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Nona Fulk, MD
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Paige Holt, MD
Champaign-Urbana • Carle Foundation Hospital & Physician Group
Le Roy • Carle Le Roy Lexington • Carle Lexington •
Christie Clinic
Mahomet • Carle Physician Group
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Carle Normal on Landmark
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Christie Clinic Community Cancer Center
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Carle Surgicenter
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Carle Therapy Services
Gailey Eye Clinic, Ltd.
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Carle Therapy Services
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Christie Clinic
Bloomington Eye Center
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Christie Clinic
he Center for Outpatient T Medicine
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The Eye Center
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Arrow Medical Services
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dvanced MRI Central IL A Neuroradiology
Danville • Carle Physician Group
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Dr. Weaver & Associates
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Retina Consultants
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Carle Surgicenter
General & Colon Rectal Surgery
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Carle Therapy Services
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Christie Clinic
McLean County Foot & Ankle, Ltd.
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The Eye Center
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McLean County Orthopedic McLean County Neurology Central Illinois Neuroradiology, Ltd. Bloomington Counseling Services Digestive Disease Consultants Summit Family Medical Center Obstetrics & Gynecology IL, Ltd.
El Paso • Carle El Paso Eureka Carle Eureka Hospital
Mattoon-Charleston • Carle Physician Group Monticello Carle Physician Group
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Christie Clinic
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Kirby Medical Center
Rantoul • Carle Physician Group •
Carle Therapy Services
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Christie Clinic
Roanoke • Carle Roanoke
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Carle Eureka
Hoopeston • Hoopeston Community Memorial Hospital & Physicians •
Carle Physician Group
Rossville • Rossville Medical Center St. Joseph Christie Clinic
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TIER 2
Visit simplete.org/medicare for the full provider list.
Atwood • Piatt County Mental Health Bloomington-Normal Central Illinois Orthopedic Surgery
Decatur • Central Illinois Health Care Associates •
Decatur Memorial Hospital
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St. Mary’s Hospital
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Chestnut Health Systems
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Orthopedic & Sports Enhancement Center
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OSF Medical Group
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OSF St. Joseph Medical Center
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Renalcare Associates, SC
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Soderstrom Dermatology Center
Cerro Gordo • Piatt County Mental Health Champaign-Urbana • Gailey Eye Clinic, Ltd. •
SF Heart of Mary Medical Center & O Physicians
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Prairie Center Health Systems
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Promise Healthcare
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Rosecrance, Inc.
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The Pavilion Foundation
Danville • Center for Youth & Family Services •
Danville Polyclinic, Ltd.
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Family Practice Medical Center
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Gailey Eye Clinic
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Sodhi Medical Services
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OSF Sacred Heart Medical Center & Physicians
El Paso • OSF Prompt Care Eureka • Illinois Gastroenterology •
OSF Multi-Specialty Group
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Premier Medical Group
Fisher • Family Healthcare of Fisher Gibson City • Gibson City Area Hospital & Clinics Homer • Mahindra D. Patel, MD Hoopeston • Family Healthcare of Hoopeston Kankakee Riverside Medical Center & Physicians
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Lincoln • Abraham Lincoln Memorial Hospital Macomb • McDonough District Hospital & Physicans Mahomet • Family Healthcare of Mahomet
Mattoon-Charleston • Sarah Bush Lincoln Health Center & Physicians Metamora • OSF Multi-Specialty Group •
Methodist Medical Group at Metamora
Monticello • Foot & Ankle Center of Illinois •
Piatt County Mental Health
Olney Carle Richland Memorial Hospital & Physicians
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Paris • Paris Community Hospital & Physicians Peoria OSF Medical Group
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Springfield • HSHS Medical Group •
Memorial Medical Center & Physicians
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SIU Physicians
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HSHS St. John’s Hospital
Springfield Clinic at the following locations: • Altamont • Mt. Pulaski •
Carlinville
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Neoga
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Decatur
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Newton
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Effingham
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Nokomis
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Flora
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Raymond
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Hillsboro
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Riverton
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Jacksonville
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Sherman
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Lincoln
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Springfield
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Macomb
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Stewardson
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Moweaqua
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Taylorville
Southern Illinois • Center for Medical Arts and Harrisburg Primary Group
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OSF St. Francis Medical Center
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UnityPoint Health - Pekin
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Chester Medical Group
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UnityPoint Health - Methodist
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Franklin Hospital
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UnityPoint Clinic - Peoria
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Harrisburg Medical Center
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UnityPoint Health - Proctor
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Herrin Hospital
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UnityPoint Clinic - Pekin
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Memorial Hospital of Carbondale
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Shawnee Health Services
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SIU – Family Medicine
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St. Joseph Memorial Hospital
Robinson • Crawford Memorial Hospital & Physicians
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. Plus, get a $150 allowance for eyewear. Comprehensive Dental Simplete members get $1,500 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. Simplete plans include all Medicare-covered dental services but also offer non-Medicarecovered dental services as well. These additional benefits* include but are not limited to:
Hearing Benefit 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. Acupuncture If you have a qualifying diagnosis, your Simplete coverage includes acupuncture treatments. Qualifying diagnoses include headache, neck pain and lower back pain.
Coverage Wherever You Go Get coverage from home: •
Virtual health coverage.
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Nurse Advice Line.
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Oral exams.
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Cleanings.
Get coverage when traveling:
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X-rays.
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Fluoride treatments.
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Fillings.
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Dentures.
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Denture adjustments and repairs.
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Crowns.
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Treatments for gum disease.
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Bridge work.
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Root canals and extractions.
* Cost-sharing may apply. See Summary of Benefits (SOB) for coverage details.
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Urgent and emergency care worldwide. No matter what happens or what urgent care/emergency department you visit, it won’t cost more than it would at home. Additional medical and non-medical benefits are 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/medicare, 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: •
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(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 Medicaid 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/medicare.
COSTS IN THE INITIAL COVERAGE PERIOD 30-DAY DRUG COST BY TIER
Simplete 1 (HMO) Simplete 2 (HMO) Simplete 3 (HMO-POS)
Tier 1 - $2 Tier 2 - $15 Tier 3 - $47 Tier 4 - 50% Tier 5 - 33%
Catastrophic Coverage This coverage begins when your out-of-pocket drug costs reach $BUBTUSPQIJD $PWFSBHF $7,050. At this stage, we pay for most of your drug costs for the rest 5IJT DPWFSBHF CFHJOT XIFO ZPVS PVU PG QPDLFU ESVH DPTUT of the year, while you pay the greater of the following:
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Coverage Through the Gap If your total prescription spend adds up to $4,430, you’ll reach the coverage gap. With your Simplete plan, you’ll continue to pay your copay for Tier 1 medications until your out-of-pocket expenses reach $7,050.
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 toward a healthy lifestyle. This includes: •
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Optimizing health benefits to save money. Helping prevent illness and hospital stays.
Here are some of the ways we help: •
Finding helpful resources.
Health Coaching Health coaches are your health partners. They’ll help you reach your health goals in the following areas and more: •
Nutrition.
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Weight loss.
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Staying active.
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, dietitians, pharmacists and health coaches – all working together on your behalf.
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After being diagnosed with diabetes, it can be very confusing to manage new medications, blood sugar levels and a new diet. We help remove confusion and keep things on track. 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: • •
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Annual wellness visits. Routine cancer screenings (including mammograms and colonoscopies). Cardiovascular disease risk-reduction visits.
inconvenience of going to the doctor’s office or sitting in a waiting room. And with the virtual visit benefit, you can connect with a board certified doctor or counselor by phone, secure video or our member app, 24/7. Be Fit Get paid back for a variety of fitness activities. You choose how you want to work out, and we pay you back up to $360 a year. Activities include the following and more:
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Flu shots.
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Bone mass measurements.
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Depression, diabetes and HIV screenings.
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Hepatitis B and pneumococcal shots.
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Medical nutrition therapy.
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Fitness class fees.
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Rowing.
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Obesity screening and therapy.
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Gym memberships.
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Golf.
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Tennis.
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Screening and counseling to reduce alcohol misuse. Screening for sexually transmitted infections (STIs) and counseling to prevent STIs. Counseling to stop smoking or tobacco use. “Welcome to Medicare” preventive visit (one time).
Nurse Advice 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 through virtual health coverage. With the telehealth benefit, you can connect with your primary care provider or specialist over the phone or online without the
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Online fitness subscriptions. Weight loss subscriptions.
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Ski memberships.
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Bowling.
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Recreational league fees. Pool exercise classes. 5K/10K race fees.
If your fees are more than $360 a year, you pay the difference. If they’re less, we pay you back the amount you paid. Be Fit doesn’t cover fitness trackers, personal trainers or personal equipment. Wellness Rewards 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.
Perks OTC4Me Get a 10% discount code for a wide variety of competitively priced over-the-counter (OTC) products with OTC4Me. You can order online or by phone, and all orders are shipped directly to you. Shipping is free on orders over $25. whiskerDocs Connect to 24/7 help from veterinary technicians with whiskerDocs. You can call, chat or email with questions about your animals’ health or well-being. The service helps with cats, dogs, birds, reptiles and pocket pets (like rabbits or hamsters). About 60% of issues are taken care of over the phone without a visit to the veterinarian. Companion Benefit Get up to 30 hours a year of in-home support through PAPA if you have asthma, congestive heart failure, chronic obstructive pulmonary disease (COPD), vascular disease or diabetes.
Hally® App Manage your health plan and get the care you need anytime, anywhere. •
See all your account activities in one place.
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Access your virtual ID card.
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Search for doctors and other resources.
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Quickly connect with a doctor over virtual visits.
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Get cost estimates.
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Check claims status.
Visit the App Store or Google Play to download the Hally app. 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.
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Companionship.
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 tobaccocessation program. This service helps you quit for good by using:
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Transportation.
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One-on-one coaching from a quit coach.
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Technical support.
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A personalized quit plan.
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Light help around the house.
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Helpful tools, like Text2Quit®.
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Light exercise.
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Grocery shopping.
Services include:
An in-network doctor or licensed plan provider must request these services. Services are provided in two-hour increments.
Web Coach®, an online learning and support community.
Coverage While You Travel From Suitcase to Worst Case You’ve worked hard your whole life and 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. Access to Worldwide Emergency and Urgent Care 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 a Nurse Advice Line worldwide so you can get care and answers to health questions whether you’re at home or away. 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: •
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Prescription assistance if you need medication or left your prescription behind. Emergency medical evacuation. Help returning home if you need medical care.
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Lost luggage assistance.
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Interpreter and legal referrals.
* Members may have additional costs related to travel services.
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®. 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? •
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If it’s an urgent or emergency 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 of network for an extended period of time? •
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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? •
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If you have a POS plan, you can use your out-of-network benefits to see an out-of-network specialist or provider without prior authorization. If you have an HMO plan, you’ll need to receive prior authorization from Simplete for your claims to be covered. If the specialist is in the Simplete network, we don’t require a referral or prior authorization 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.
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 stand-alone prescription drug plan, or you can switch plans. If you enroll during this period, your coverage begins January 1 of the following year.
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: • •
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 you turn 65, and ends three months after the month you turn 65.
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If you enroll one to three months before the month you turn 65, your coverage begins the first day of the month you turn 65. If you enroll during your birth month, your coverage begins the first day of the following month. 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.
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. •
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Permanent address change.
You must continue to pay your Medicare Part B premium if not otherwise paid for by Social Security or another third party.
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.
Enrollment Process Enrolling Online Visit simplete.org/medicare to get started. Enrolling by Phone 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. 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/medicare. 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, 2022. 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 a 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/medicare. Our secure member website stores important plan information in one easy place. You can download the Hally app at the App Store or Google Play. Meet us in our local office. Stop by our office for a visit: 3301 Fields South Dr., Suite 105 Champaign, IL 61822 Weekdays 8:30 a.m. to 4:30 p.m. We look forward to meeting you.
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 (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 (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: Champaign • McLean • Piatt • Vermilion • Woodford INDIANA: Fountain • Vermillion • Warren
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Simplete Local Star Ratings Click on the link below to view the most up-to-date star ratings for your service area. 2021 Simplete Local Star Ratings 2022 Simplete Local Star Ratings (Available Mid-October 2021)
Simplete is powered by Health Alliance Medicare - a Medicare Advantage Organization with a Medicare contract. Enrollment in Simplete depends on contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system. MDMKSI22-LOCstarrtgissuu-0921 | H1463_22_101981_M