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Information for Members
Welcome Essence Members!
Can Your Benefits Change During the Year?
Generally, your benefits will not change during the year. The Medicare program does not allow us to decrease your benefits during the calendar year. We are allowed to decrease your benefits only on January 1, at the beginning of the next calendar year. The Medicare program must approve any decreases we make in your benefits. We will tell you in advance if there are going to be any increases or decreases in your benefits for the next calendar year.
At any time during the year, the Medicare program can change its national coverage. Since we cover what Original Medicare covers, we would have to make any change that the Medicare program makes.
2008 Annual Notices of Change
Members, please view the 2008 Annual Notice of Change Letter sent to all of our members, that highlights important benefit changes from 2007 to 2008.
In addition, the following questions are answered in the 2008 Annual Notice of Change (Standard Plan) and 2008 Annual Notice of Change (Enhanced Plan):
- How will my monthly premium change for 2008?
- How will my prescription drug coverage and cost-sharing change for 2008?
- What if my drug is no longer on the formulary or is in a more expensive cost-sharing tier in 2008?
- What do I need to know if I'm getting extra help from Medicare to pay for my prescription drugs?
- How will my other benefits and cost-sharing change for 2008?
- When can I switch from one Medicare plan to another?
- Where can I get more information?
Keep Your Membership Record Up-To-Date
Essence has a membership record about you as a plan member. Doctors, hospitals, pharmacists, and other plan providers use this membership record to know what services and drugs are covered for you. The membership record has information from your enrollment form, including your address and telephone number. It shows your specific Essence coverage, the Primary Care Physician you chose when you enrolled, and other information.
Please help us keep your membership record up-to-date by letting Member Services know right away if there are any changes to your name, address, or phone number, or if you go into a nursing home. Also, tell Member Services about any changes in health insurance coverage you have from other sources, such as from your employer, your spouse's employer, workers' compensation, Medicaid, or liability claims such as claims from an automobile accident.