Frequently asked questions

 How do I enroll?

You have several options:

  • Enroll online for Medicare Advantage, Medicare Part D or Medigap
  • Enroll by U.S. Mail or fax. Download an application from the "Enrollment" tab of the Forms & documents pages for a Medicare Advantage, Part D or Medigap plan. Return a separate application for each person you wish to enroll. Mail to the address listed on the form or fax to 1 (888) 335-2988.
  • Enroll by phone at 1 (844) 278-7472 (TTY: 711). Hours: 8:00 a.m. to 5:00 p.m., Monday through Friday. October 1 through March 31, phone hours are 8:00 a.m. to 8:00 p.m., seven days a week.

To receive more information on plan options contact us at 1 (844) 278-7472.

 What are my payment options?

You have the choice of paying for your plan when we bill you, or you can sign up to automatically pay from your bank account. To set up automatic payment, complete the bank authorization section on the enrollment form. For Medicare Advantage and Part D plans you can also choose to have your plan premium taken out of your monthly Social Security check. To learn more, call 1 (844) 278-7472.

 I have a limited income. Can I get help with my Medicare prescription drug costs?

You may be able to use a program called Extra Help. To see if you qualify for Extra Help for your prescription drug costs, call any of the following:

  • Medicare: 1 (800) MEDICARE (633-4227). TTY: 1 (877) 486-2048. Offices are open 24 hours a day, seven days a week.
  • Social Security: 1 (800) 772-1213. TTY: 1 (800) 325-0778. Offices are open from 7:00 a.m. to 7:00 p.m., Monday through Friday.
  • Your state Medicaid office.
 When will my coverage take effect?

As soon as Medicare verifies your eligibility, we will notify you of your effective date. If you are newly eligible for Medicare, you may submit your application up to three months before your effective date.

For Medigap, subject to meeting eligibility requirements, your coverage will begin on the first day of the month following our acceptance of your application.

 What are the differences between HMO, PPO and Medigap plans?

Health maintenance organizations (HMOs) are managed care plans that require you to use only contracted doctors and hospitals (in a specific provider network) to receive benefits; typically, you need a referral to see a specialist.

Preferred provider organizations (PPOs) also have a provider network. You're covered if you visit providers outside the network, but you will pay more.

Medigap plans are secondary to Medicare. They don't have a provider network, and they usually cost more than HMOs and PPOs. Most Medigap plans don't offer prescription drug, dental or vision coverage.

 Is there prescription drug coverage for Medigap plans?

No. Medigap provides prescription discounts only and is not a prescription drug plan. Some older Medigap policies prior to January 1, 2006 may have included prescription drug coverage. These plans are no longer sold (Plans H, I and J). If your policy was effective after January 1, 2006 show your ID card for Rx discounts only.

 How do I get care under my new plan?

Show your member card to your health care providers at each visit so they know whom to bill. In most cases, there is virtually no paperwork. You'll receive a new member welcome packet with more information and you can call us if you have any questions.

 Will you be contacting me?

Yes, we may call you directly or we may use one of our partners to call you. When we talk to you we may ask for your contact information. It's very important that we have your current information.

In addition to calling you, we may also send you letters or other information that can help you manage your health. If you have any questions or concerns about a call or letter you receive from us, we encourage you to call Customer service. We'll be happy to assist you in any way.

 Do you have any programs to help me maintain or improve my health?

We offer a number of programs that help promote healthy living. These include:

  • A 24-hour nurse phone line
  • Preventive service and screening reminders for Medicare Advantage members
  • Informative care programs on asthma, COPD, congestive heart failure, coronary artery disease and diabetes
  • The Silver&Fit® Program–Access to more than 14,000 participating fitness facility locations across the country, where you can use the equipment, attend group fitness classes or the option to enroll into the Home Fitness Program
  • Access to our members-only website with additional resources
 What happens if I travel outside the service area for an extended period?

Asuris Medicare Advantage plans will cover you for medical emergencies anywhere in the world. If you have to go to a hospital emergency room, you'll pay a copay or coinsurance amount. For nonurgent or routine care you may have to pay more if you visit an out-of-network provider.

  • Asuris Medigap plans: If traveling within the United States, you have the choice of any Medicare approved provider. Medigap Plans C and F provide emergency coverage when traveling outside of the United States.
  • Medicare Part D prescription drug plans: We have more than 63,000 participating pharmacies nationwide, including most national chains. You may have to pay more if you go to an out-of-network pharmacy. Pharmacy coverage is not available outside the United States and its territories with stand-alone Prescription Drug Plans (PDP) and our Medicare Advantage plans.
 What happens if I move out of the service area?

Asuris plans are only available to those who live in the plan service area. If you move, call us to explore other options. You could also return to Medicare Parts A and B.

 How often will my rates go up?

For Medicare Advantage plans, any rate increases are effective in January. After that, your monthly premium is guaranteed not to change until January of the following year. We will notify you every fall about any rate or benefit changes for the coming year.

Medigap rate changes happen annually, at your policy's renewal. We will notify you of rate changes prior to your renewal date.

 Does it cost more to buy coverage through an agent?

No. There is never an extra cost or obligation if you use an appointed agent. Agents, who are appointed to represent Asuris, provide a valuable service and often can help you decide which of our Medicare plans is best for you.

 What if I don't want the prescription drug coverage?

Choose the Asuris Esteem (PPO) plan. Keep in mind that if you don't have other creditable drug coverage and don't choose a Medicare Part D prescription drug plan when you're eligible, there will be a penalty for every month you could have enrolled but didn't. So, you'll pay more for prescription drug coverage if you enroll later and can't prove you had other, creditable prescription drug coverage.

Medigap plans do not offer prescription drug coverage.

 What's the advantage of choosing the Asuris TruAdvantage + Rx Primacy (PPO), + Rx Classic (PPO) or the + Rx Enhanced (PPO) plan?

These plans give you the convenience of having prescription drug coverage and your medical coverage in a single plan. In addition, you don't have to worry about choosing another Medicare Part D prescription drug plan, or incurring a penalty if you don't enroll during your enrollment period. If you do choose a stand-alone Medicare Part D plan, you'll automatically be disenrolled from your Medicare Advantage health plan.

 How does the prescription drug coverage gap work?

The different coverage gap stages and out-of-pocket costs information is explained in the Summary of Benefits document.

 How are eye exams covered?

Medicare covers diagnosis and treatment for eye conditions. Members with diabetes can get a dilated eye exam every calendar year. In addition, Medicare Advantage covers one routine vision eye exam every year.

Medigap plans do not cover routine eye exams but may cover some preventive and diagnostic eye exams.

 After I join, may I disenroll if I want to?

Asuris Medicare Advantage or Medicare Part D plan plan membership is optional. If you change your mind and meet the eligibility requirements, you can disenroll during your annual election period, the Medicare Advantage Disenrollment Period (MADP), or if you qualify for a special election period.

  • Disenrollment requests are subject to eligibility for a qualifying election period and must be submitted in writing (such as moving outside of the service area, obtaining group coverage, enrolling in a MAPD plan with another carrier, low income subsidy (LIS), etc).
  • Disenrollment requests received outside of a qualifying election period will not be honored. Note: LIS/dual eligibility members have a continuous SEP available and may disenroll at any time.
  • Disenrollment requests that will be honored include requests received during AEP (October 15 to December 14) and MADP (January 1 to February 14) and will take effect the first of the following month.

Send written requests for Medicare Advantage or Part D plans to:

Attn: Membership Accounting M/S B32M
P.O. Box 1827
Medford, OR 97501-0143
Fax: (888) 335-2988

Medigap plans can be cancelled by the member at any time, in writing or by calling Customer Service.

 On what basis could my Asuris Medicare coverage be canceled?

Medigap, Medicare Advantage or Medicare Part D coverage would be canceled if:

  • You don't retain Medicare Parts A and B
  • You fail to pay the monthly premium, subject to a 60-day grace period
  • You commit fraud or allow someone else to use your member card to obtain services
  • You intentionally misrepresent information on your application form that affects your eligibility to enroll in this plan

Medicare Advantage or Part D coverage would also be canceled if:

  • You are disruptive, abusive, unruly or uncooperative to the extent that your behavior seriously impairs our ability to provide services to you. Involuntary disenrollment is subject to prior approval by the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare and helps protect your rights.
  • You permanently move out of our service area and don't voluntarily disenroll.
  • CMS were to stop allowing Regence to provide Medicare Advantage or Part D coverage.
  • Regence chooses to no longer offer Medicare Advantage or Medicare Part D plans.
 What key Utilization Management (UM) procedures does the plan use?

UM is the way we review the type and amount of care you’re getting. This involves looking at the setting for your care and its medical necessity. Clinical professionals make decisions based on our clinical review criteria, guidelines and medical policies. Examples of UM procedures are: pre-service review (prior-authorization), concurrent review (including urgent concurrent review) and post-service review.

Preservice review
Some treatments and services need what’s called a pre-service or prior-authorization review. That means that your doctor or other provider needs to check with us in advance to make sure we can cover the treatment, drug, equipment, complex diagnostic test or hospital admission.

Urgent concurrent review
Concurrent review happens while care or services are being received. The goal of the review is to determine coverage, be sure that care is medically necessary and provided in the most appropriate care setting, start a discharge and continuing care plan and coordinate referrals to other programs and resources.

If you are admitted to a hospital or other facility for urgently needed medical or mental health care, the health plan performs urgent concurrent review when we are notified instead of reviewing the case before the admission.

Post-service review
This review occurs after care has been received or services have been performed. It is also called retrospective review. Post-service review is conducted to determine we can cover the treatment, drug, equipment, complex diagnostic test or hospital admission.

Appeals
You have the right to appeal, or request an independent review of, any action we take or decision we make about your coverage, benefits or services. You can appeal through either a written or verbal request. There are several levels of appeal, including internal and external appeal levels, which you may follow. Contact us as soon as possible because time limits apply.

 When is pre-authorization (also called prior authorization) required?

Some medical procedures require pre-authorization before you receive treatment in order to get coverage from your health plan.

Pre-authorization allows us to review your treatment within the context of any other health issues you may have and to consider the latest scientific research available to manage your condition. Some conditions have a wide range of treatment choices, and some treatments work better than others. Checking in on your progress after a series of treatments helps us make sure your treatment is effective, medically necessary and right for you.

These treatments, services and equipment may require pre-authorization:

  • Some surgeries and reconstructive surgery
  • Planned admission into hospitals or skilled nursing facilities
  • Transplant and donor services
  • Specialized imaging such as MRIs, CT scans and cardiac imaging
  • Non-emergency air ambulance transport
  • Prosthetics and some orthotics
  • Home medical equipment
  • Interventional pain procedures
  • Physical medicine services such as physical therapy and chiropractic care
  • Sleep studies

These prescription medications may require pre-authorization:

  • Some high-cost injectable medications
  • Specialty drugs

If a doctor does not get pre-authorization before treating you, your health plan will not cover those costs and the doctor may bill you for that treatment.

If you use an in-network doctor, you don't need to do anything. The doctor's office will handle the pre-authorization process. Our clinical partner evaluates your treatment plan to make sure it is the most effective treatment based on published research. Our partner also ensures that it is medically necessary and covered by your health plan.

If you use an out-of-network doctor, call the number on the back of your member ID card and we can talk with you about your options. Using an out-of-network doctor may mean higher out-of-pocket costs for you.

Resources

Need coverage? Call 1 (844) 278-7472, TTY: 711 8:00 a.m.-5:00 p.m., Mon.-Fri.

Members: Call 1 (800) 541-8981, TTY: 711 8:00 a.m.-8:00 p.m.  April 1 – September 30, Mon.-Fri.
October 1 – March 31, seven days a week

Pharmacy: Call 1 (844) 765-6825, TTY: 711 24 hours a day, seven days a week

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Last updated 11/01/2021
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