Q: How can I reach Customer Service?
A: Customer Service can be reached by phone at 434-947-3671 or toll-free 1-877-210-1719 from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. From February 15 through September 30, Customer Service is available 8:00 a.m. to 8:00 p.m., Monday through Friday. TTY users should call 7-1-1. Walk-ins are welcome 8:30 a.m. to 5:00 p.m., Monday through Friday.
Q: If I enroll in Piedmont Medicare Advantage, do I still have to pay my part B premium?
A: Yes. You will continue to pay a premium each month for Medicare part B (Medical Insurance).
Q: Do I need a referral to see a doctor or specialist?
A: No. You can go to doctors, specialists, or hospitals in or out-of-network. You may have to pay more for the services you receive outside the network.
Q: Does Original Medicare cover all of my health care costs?
A: Medicare covers many services; however, you will still accumulate out-of-pocket costs including copays, deductibles and coinsurance. Piedmont Medicare Advantage (PPO) provides additional coverage resulting in less out-of-pocket costs.
Q: Do you offer a mail order discount on prescription drugs?
A: Yes. We offer a 90-day mail order supply at a considerable lower cost-sharing level for prescription drug discount. In addition, for 2018, there will be a co-pay level of $0 for a 90-day supply of Tier 1 - Preferred Generics and Tier 2 - Generics under all Piedmont Medicare Advantage plan options at a preferred mail order pharmacy. For details on mail order options, visit the Prescription Drug Benefits section of the Summary of Benefits.
Q: What premium payment options are available?
A: There are two ways to pay your premium. You can pay your premium through deduction from your Social Security or Railroad Retirement benefits check. You may also pay your premium with a check or money order. With this option, you will receive a monthly bill prior to the due date as a reminder.
Q: Is vision included?
A: With a low copayment you will be able to receive one pair of eyeglasses or contact lenses after cataract surgery, and exams to diagnose and treat diseases and conditions of the eye, including an annual glaucoma screening for people at risk. For the 2018 benefit year, Piedmont Select Medicare Option One, Piedmont Select Medicare Option Two, and Piedmont Select Medicare Option Three will continue to include an annual routine eye exam. Piedmont Select Medicare Option One benefits include a $150 allowance every two years for eyeglasses (frames and lenses) from any provider.
Q: Do you offer any additional supplemental benefits?
A: Yes. For the 2018 benefit year, we will continue to offer the 24/7 Nurse Advice Line and SilverSneakers® Fitness program. In addition, a new service called Centra 24/7 (Remote Access Technology) will be offered to all members. For more information on these additional supplemental benefits, see Chapter 4 of the Evidence of Coverage or CLICK HERE.
Q: What immunizations are covered at 100%
A: The Pneumonia vaccine, Influenza vaccine, Hepatitis B vaccine (if you are at high or intermediate risk) are all covered at 100%.
Q: Am I covered in case of an emergency if I am out of town or even out of the country?
A: Yes, <for 2017 there is a $75 copay per emergency room visit within the United States and its territories.> For 2018, there is a $80 copay per emergency room visit within the United States and its territories. If you receive emergency care at an out-of-network hospital and need inpatient care after your emergency condition is stabilized, you must move to a network hospital in order to pay the in-network cost-sharing amount for the part of your stay after you are stabilized. If you stay at the out-of-network hospital, your stay will be covered but you will pay the out-of-network cost-sharing amount for the part of your stay after you are stabilized. Emergency care must be furnished by a provider that is qualified to provide emergency services and evaluate or stabilize an emergency medical condition. There is a $25,000 plan coverage limit for emergency services outside the U.S. every year..
Q: If I enroll in Piedmont Medicare Advantage, will I lose my Original Medicare coverage?
A: No, you still have Medicare. Once you join Piedmont Medicare Advantage, we will cover all the services that original Medicare covers with the exception of Hospice Care and Clinical Research studies.
Q: Do I have to re-enroll during the Annual Enrollment Period?
A: If you are a member of Piedmont Medicare Advantage and want to keep your current plan, your coverage will automatically renew. Please refer to your ANOC/EOC for changes to your benefits in the upcoming year. If you would like to make a change you can do so during the Annual Enrollment Period (October 15 through December 7).
Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. 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. You must continue to pay your Medicare Part B premium. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. 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. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2017 Tivity Health, Inc. All rights reserved.
H1659_Web2018 Approved 10112017
Last Updated 10/16/2017