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 You are eligible to join if:
- You are enrolled in the Federal Medicare Program hospital
insurance "Part A" and the medical insurance "Part B" or
the medical insurance "Part B" only.
- You reside within our Service Area (Alamakee, Dubuque,
Clayton, Delaware, Jackson and Jones Counties)
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You are not eligible to join if:
- You are presently an End Stage Renal (kidney) Dialysis
patient or have received a Kidney Transplant within the
last thirty six (36) months.
- You have elected Hospice care under the Medicare program.
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Remember...
- You are not required to answer any health questions.
- Your coverage is good for Medicare covered services.
- Your contract cannot be cancelled because of your age
or the amount of the benefits you use.
- Your premium cannot be changed due to the amount of benefits
you use.
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When am I covered?
You must enroll by the first of the month to be eligible for
coverage to begin the first of the following month, (i.e., sign
up by January I to be eligible for February 1).
What are some of the advantages of joining?
- We combine our benefits with those of Medicare and assume
responsibility for nearly all your medical needs.
- There is virtually no paperwork for filing claims.
- Nearly all deductibles and co-insurance are covered in
full.
- You do not have waiting periods for pre-existing conditions.
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Payment Options
We will deduct your premium directly from your checking account
on a monthly basis. Or, you may pay us monthly, quarterly, or yearly
by payment book.
Disenrollment rights:
The Health Plans may disenroll a Medicare member only under
one or more of the following conditions: 1) failure by the member
to pay the premium within thirty (30) days after the date when it
is due; 2) an enrollee's behavior is disruptive, abusive, or uncooperative
to the extent of affecting the Plan's ability to furnish services;
3) a member allowing a non-member to use the Health Plans identification
card to obtain services; 4) a member being outside the Health Plans
enrollment area for more than 90 consecutive days; 5) loss of entitlement
to Medicare; or 6) a fraudulent statement by the applicant.
The Medicare member may disenroll by submitting a written, signed,
and dated request to the Health Plans office.
Which doctors and hospitals must I use?*
You must use the member hospitals and physicians of the Medical
Associates Health Plans unless medical care is required under emergency
conditions. Only those services provided by or arranged through
a Medical Associates Health Plans physician will be covered.
What if I am away from the area?
Emergency services are covered for Medicare-covered services. Should
you experience an illness or injury of an emergency nature away
from the area and treatment cannot be postponed until you get home,
you are still covered. If hospitalized, you should notify the Health
Plans within 48 hours.
We want to satisfy:
The plan's Executive Officers and/or The Center, an organization
that contracts with Medicare for reviewing requests for reconsideration,
will investigate and respond to the member with appropriate action.
A standard reconsideration process is in place. The process also
is in place for expedited or fast review and appeal is available
in cases where the denial may impact your ability to regain full
function if the decision is delayed. Any grievance concerning the
Health Plans services or procedures that cannot be resolved informally
may be submitted for review by completion of the "Enrollee Grievance
Form." Copies are available by contacting the Health Plans. The
member can further request a hearing by the Grievance Committee
of the Board of Directors. If not fully satisfied, members may bring
their case to the full Board of Directors for a fair and equitable
resolution of the problem.
What if I need special medical services not available in the
area?
Even if special medical services are not available in your area,
your Medical Associates Health Plans physician will arrange for
necessary care. When you are referred by a Medical Associates Health
Plans physician and it's a Medicare approved service and it's approved
by the Medical Director, you're covered.
* A current list of member physicians and hospitals
is always available from the Medical Associates Health Plans office.
This page describes the essential features of the
Medical Associates Health Plans Advantage Plan and Advantage Plus
Rider in general terms, and is not intended to be a full description.
The complete program is described in the Subscriber
Agreement Certificate which is issued to all subscribers ad is available
on request.
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