If you are an Elderplan FIDA Total Care (Medicare-Medicaid) participant, your disclaimers are different. Please click here to review them.
Elderplan is an (HMO) plan with Medicare and Medicaid contracts. Enrollment in Elderplan depends on contract renewal. You must continue to pay your Medicare Part B premium if not otherwise paid for by Medicaid.
Members must receive all routine care from plan providers.
Benefits, premiums, and /or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Authorization rules may apply for certain services. Limitations, copayments and restrictions may apply. Members may enroll in Elderplan only during specific times of the year. Dual eligible members may enroll all year round. Contact Elderplan for more information. Plan materials are available in alternative formats or languages. Please call Elderplan’s Member Services Department at 1-800-353-3765 (TTY: 711 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week, to request materials in alternate formats.
Elderplan has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12.31.2018 based on a review of Elderplan’s model of care.
Elderplan’s pharmacy network includes retail, mail order, long-term care and home infusion pharmacies. For mail order information and additional information about network pharmacies, contact Elderplan’s Member Services Department at 1-800-353-3765 (TTY: 711 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week. Information may also be obtained by writing Elderplan, Attention: Member Service Department, 6323 Seventh Ave., 3rd Floor, Brooklyn, NY 11220-4711.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply
Out-of-network/non-contracted providers are under no obligation to treat Elderplan members, except in emergency situations. For a determination 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
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: