If you have questions or need help with your health care, please call our Customer Service Department at:
1-877-412-2734 (toll free)1-714-246-8711 (fax)
24 hours a day/ 7 days a week.
Members with hearing or speech impairments can call the TDD/TTY line at 1-800-735-2929.
We also provide interpreter services at no cost to our members.
We have staff who speak your language.
Tenemos personal que habla su idioma.
Chúng tôi có nhân viên nói cùng ngôn ngữ với quý vị
Medicare Part D is a federal-government program that subsidizes the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. Under OneCare (HMO SNP), your Part D pharmacy benefits are included as part of your coverage.
A formulary is a list of covered drugs under OneCare. OneCare will generally cover the costs of drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a OneCare network pharmacy and other plan rules are followed.
Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. To get updated information about the drugs covered by OneCare, please visit our Website www.caloptima.org or call Customer Service.
New members to OneCare may be taking drugs not on our formulary or subject to certain restrictions. Members should talk to their Primary Care Provider (PCP) to decide if they can switch to an appropriate drug we cover or request an exception. Current OneCare members may also request an exception if their PCP prescribes a drug not covered.
OneCare members have rights under Medicare to file a grievance or an appeal. Also, members with limited income and resources may qualify for assistance to help pay for prescription drugs.
Date Revised September 29, 2016
To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.H5433_WEB1004 Approved (11/15/16) OneCare (HMO SNP) is a Medicare Advantage organization with a Medicare contract. Enrollment in OneCare depends on contract renewal. Eligible beneficiaries can enroll at any time. Eligible beneficiaries must have Part A and Part B to enroll in the plan. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Other Pharmacies/Physicians/Providers are available in our network. Medicare beneficiaries may also enroll in OneCare (HMO SNP) through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare has neither reviewed nor endorsed this information. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. OneCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available for free in other languages. Please call our customer service number at 1-877-412-2734, 24 hours a day, 7 days a week. TDD/TTY users should call 1-800-735-2929. Materials available on this Website in PDF format may require the free Adobe Reader to view. To download Adobe Reader for free from the Adobe Website,click here.
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