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2011 Desert Preferred Choice (HMO)

Desert Preferred
 Desert Preferred Choice (HMO)
$0 Copay for Doctor, $0 Hospital / $0 Specialists, $0 copay Preferred Generic.
Includes: $0 copay Doctor, Hospital, Vision, Dental and $0 copay for preferred Generic drugs, covered through the gap.

Desert Preferred Choice (HMO) is a provider specific plan.  Not all Inter Valley Health Plan providers are available to Desert Preferred Choice (HMO) members.  This Plan is offered through Desert Oasis Healthcare located in the Coachella Valley of Riverside County.

Plan available in portions of Riverside County only


Easy Ways to EnrollPhoneIn PersonOnlineFaxMail


 Medicare Part D Prescription Benefits:
           
                                   

•  No Health Plan Premium
•  $0 Preferred Generics Covered in the Gap
•  $3 Non-preferred Generics   
•  $25 Preferred Brands 
 

 Healthcare Highlights:                                        
•  $0 Doctor Visit
•  $0 Hospitalization   
•  Dental, Transportation, Gym Membership
  

For more information, please download the following files
(requires Adobe Acrobat Reader.)

2011 Summary of Benefits

2011 Drug Formulary                               2011 Formulary Changes

2011 Annual Notice of Change/Evidence of Coverage                                    
2011 Evidence of Coverage Large Print

2011 Plan Rating Sheet

Alternate Formats


Download Adobe Reader at

Download Adobe Reader


Medicare Part D Prescription Benefit Questions

Part D Frequently Asked Questions


Plan Summary Questions


How Can I Compare My Options?

Where Is Inter Valley Health Plan Desert Preferred Choice (HMO) Available?

Who Is Eligible To Join Inter Valley Health Plan Desert Preferred Choice (HMO)?

Can I Choose My Doctors?

What Happens If I Go To A Doctor Who’s Not In Your Network?

Where Can I Get My Prescriptions If I Join This Plan?

Does My Plan Cover Medicare Part B or Part D Drugs?

What Is A Prescription Drug Formulary?

How Can I Get Extra Help With Prescription Drug Plan Costs?

What Are My Protections In This Plan?

What Is A Medication Therapy Management (MTM) Program?

What Types Of Drugs May Be Covered Under Medicare Part B?

Where Can I Find Information On Plan Ratings?


How Can I Compare My Options?

You can compare Inter Valley Health Plan Desert Preferred Choice (HMO) and the Original Medicare Plan using this Summary of Benefits. The charts in this booklet list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers.

Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year.

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Where Is Inter Valley Health Plan Desert Preferred Choice (HMO) Available?

The service area for this plan includes: Riverside County*, CA. You must live in this area to join this plan.
* denotes partial county

Riverside County:
91752; 92028; 92201; 92202; 92203; 92210; 92211; 92220; 92223; 92230; 92234; 92235; 92236; 92240; 92241; 92247; 92248; 92253; 92255; 92258; 92260; 92261; 92262; 92263; 92264; 92270; 92276; 92282; 92292; 92320; 92324; 92373; 92399; 92501; 92502; 92503; 92504; 92505; 92506; 92507; 92508; 92509; 92513; 92514; 92515; 92516; 92517; 92518; 92519; 92521; 92522; 92530; 92531; 92532; 92536; 92539; 92543; 92544; 92545; 92546; 92548; 92549; 92551; 92552; 92553; 92554; 92555; 92556; 92557; 92561; 92562; 92563; 92564; 92567; 92570; 92571; 92572; 92581; 92582; 92583; 92584; 92585; 92586; 92587; 92589; 92590; 92591; 92592; 92593; 92595; 92596; 92599; 92860; 92877; 92878; 92879; 92880; 92881; 92882; 92883

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Who Is Eligible To Join Inter Valley Health Plan Desert Preferred Choice (HMO)?

You can join Inter Valley Health Plan Desert Preferred Choice (HMO) if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Inter Valley Health Plan Desert Preferred Choice (HMO), unless they are members of our organization and have been since their dialysis began.

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Can I Choose My Doctors?

Inter Valley Health Plan Desert Preferred Choice (HMO) has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory or for an up-to-date list visit us at http://ivhp.com. Our customer service number is listed at the end of this introduction.

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What Happens If I Go To A Doctor Who’s Not In Your Network?

If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither Inter Valley Health Plan Desert Preferred Choice (HMO) nor the Original Medicare Plan will pay for these services.

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Where Can I Get My Prescriptions If I Join This Plan?
Inter Valley Health Plan Desert Preferred Choice (HMO) has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a pharmacy directory or visit us at http://ivhp.com. Our customer service number is listed at the end of this introduction.

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Does My Plan Cover Medicare Part B or Part D Drugs?

Inter Valley Health Plan Desert Preferred Choice (HMO) does cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.

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What Is A Prescription Drug Formulary?

Inter Valley Health Plan Desert Preferred Choice (HMO) uses a formulary. A formulary is alist of drugs covered by your plan to meet patient needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members’ ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our Web site at www.ivhp.com/ivhp/pdfs/formulary.pdf.

If you are currently taking a drug that is not on our formulary or subject to additional requirements or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician’s help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy.

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How Can I Get Extra Help With My Prescription Drug Plan Costs Or Get Extra Help With Other Medicare Costs?

You may be able to get extra help to pay for your prescription drug premiums and costs as well as get help with other Medicare costs. To see if you qualify for getting extra help, 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 and see http://medicare.gov ‘Programs for People with Limited Income and Resources’ in the publication Medicare & You.
  •  The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778 or
  • Your State Medicaid Office.

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What Are My Protections In This Plan?
All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, or the Centers for Medicare & Medicaid Services decides to not renew or terminate a plan's contract, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

As a member of Inter Valley Health Plan Desert Preferred Choice (HMO), you have the right to request an organization determination, which includes the right to file an appeal if we deny coverage for an item or service, and the right to file a grievance. You have the right to request an organization determination if you want us to provide or pay for an item or service that you believe should be covered. If we deny coverage for your requested item or service, you have the right to appeal and ask us to review our decision. You may ask us for an expedited (fast) coverage determination or appeal if you believe that waiting for a decision could seriously put your life or health at risk, or affect your ability to regain maximum function. If your doctor makes or supports the expedited request, we must expedite our decision. Finally, you have the right to file a grievance with us if you have any type of problem with us or one of our network providers that does not involve coverage for an item or service. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information.

As a member of Inter Valley Health Plan Desert Preferred Choice (HMO), you have the right to request a coverage determination, which includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered. An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision. Finally, you have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information.

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What Is A Medication Therapy Management (MTM) Program?
A Medication Therapy Management (MTM) Program is a free service we offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact Inter Valley Health Plan Desert Preferred Choice (HMO) for more details.

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What Types Of Drugs May Be Covered Under Medicare Part B?
Some outpatient prescription drugs may be covered under Medicare Part B. These may include, but are not limited to, the following types of drugs. Contact Inter Valley Health Plan Desert Preferred Choice (HMO) for more details.

  • Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
  • Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.
  • Erythropoietin (Epoetin Alfa or Epogen®): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
  • Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.
  • Injectable Drugs: Most injectable drugs administered incident to a physician’s service.
  • Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility.
  • Some Oral Cancer Drugs: If the same drug is available in injectable form.
  • Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen.
  • Inhalation and Infusion Drugs provided through DME.

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Where Can I Find Information On Plan Ratings?
The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). If you have access to the web, you may use the web tools on www.medicare.gov and select “Compare Medicare Prescription Drug Plans” or “Compare Health Plans and Medigap Policies in Your Area” to compare the plan ratings for Medicare plans in your area. You can also call us directly to obtain a copy of the plan ratings for this plan. Our customer service number is listed below.

Please call Inter Valley Health Plan for more information about
Inter Valley Health Plan Desert Preferred Choice (HMO).
Visit us at http://ivhp.com or, call us:

Customer Service Hours:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, 7:30 a.m. - 8:00 p.m. Pacific

Current members should call toll-free (800)-251-8191 for questions related to the Medicare Advantage Program. (TTY/TDD (800)-505-7150 )

Prospective members should call toll-free (866)-756-4407 for questions related to the Medicare Advantage Program. (TTY/TDD (800)-505-7150 )

Current members should call locally (800)-251-8191 for questions related to the Medicare Advantage Program. (TTY/TDD (800)-505-7150 )

Prospective members should call locally (866)-756-4407 for questions related to the Medicare Advantage Program. (TTY/TDD (800)-505-7150 )

Current members should call toll-free (800)-546-5677 for questions related to the Medicare Part D Prescription Drug program. (TTY/TDD (866)-706-4757 )

Prospective members should call toll-free (866)-756-4407 for questions related to the Medicare Part D Prescription Drug program. (TTY/TDD (800)-505-7150 )

Current members should call locally (800)-546-5677 for questions related to the Medicare Part D Prescription Drug program. (TTY/TDD (866)-706-4757 )

Prospective members should call locally (866)-756-4407 for questions related to the Medicare Part D Prescription Drug program. (TTY/TDD (800)-505-7150 )

For more information about Medicare, please call Medicare at 1-800-MEDICARE
(1-800-633-4227).

TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.

Or, visit http://medicare.gov on the web.


If you have special needs, this document may be available in other formats or languages.

If you have any questions about this plan’s benefits or costs, please contact Inter Valley Health Plan for details.

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