Conditions and Limitations

Here is some important information about our Prescription Drug Plans. Please make sure to read this section carefully to learn more about your prescription drug coverage.

• To be eligible, you must be eligible for Medicare Part A or enrolled in Medicare Part B. You must also live in the plan's service area.  
• Network pharmacies include retail, mail-order, specialty, long-term care, home infusion and Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies. To obtain names and addresses of WellCare's network pharmacies, use the pharmacy search tool or current members contact Customer Service at 1-888-550-5252, Monday - Friday, 8am to 2am Eastern. Prospective members call 1-866-765-4390, Monday - Friday, 8am to 2am Eastern. TTY users call 1-888-816-5252.
• You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances (e.g., emergencies) when you cannot reasonably use network pharmacies. Quantity limitations and restrictions may apply.
• For more information on mail-order prescription drug service, current members contact Customer Service at 1-888-550-5252, Monday - Friday, 8am to 2am Eastern. Prospective members call 1-866-765-4390, Monday - Friday, 8am to 2am Eastern. TTY users should call 1-888-816-5252. Or visit us anytime at http://www.wellcarepdp.com/. For certain kinds of drugs, you can use the plan's preferred mail-order services. These drugs are marked as mail-order drugs on our Plan's Drug List. We provide mail-order pharmacy services via WellCare Specialty Pharmacy and can provide a 28 to 31-day supply (for drugs within the specialty tier) or an 84 to 93-day supply (for drugs outside the specialty tier). You will receive a reduced co-pay for additional savings on an 84 to 93-day supply. Non-preferred mail-order pharmacies require you to order at least an 84-day supply of the drug and no more than a 93-day supply. At non-preferred mail-order pharmacies, you will not be eligible for the savings available at our preferred mail-order pharmacy.
• People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this extra help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
• You can only be in one Medicare Prescription Drug Plan at a time. If you are are currently in a Medicare Prescription Drug Plan, your enrollment in WellCare will end that enrollment. Enrollment in this plan is generally for the entire year. Once you enroll, you may leave this plan or make changes only at certain times of the year when an enrollment period is available (example: you may make changes October 15-December 7 of every year), or under certain special circumstances.
• If you are enrolled in a MA PFFS plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan, you will be automatically disenrolled from the HMO, PPO or MA PFFS plan if you enroll in a PDP.
• If you are enrolled in a private-fee-for-service plan (PFFS) that does not include Medicare prescription drug coverage, an MA Medicare Savings Account (MSA) plan or an 1876 Cost plan, you may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.
  Members may enroll in the plan only during specific times of the year. Contact WellCare for more information.
• If you have qualified for additional assistance with your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in WellCare, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay.
• If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will remain responsible for payment of those premiums.
• By law, WellCare can choose not to renew our contract with CMS and CMS may also refuse to renew the contract, resulting in a termination or non-renewal. This may result in termination of your enrollment in the plan. Additionally, WellCare may reduce its service area and no longer offer services in the area where you reside.
• This information is available for free in other languages. Please contact our Customer Service number at 1-866-765-4390 for additional information.
• Esta información está disponible gratis en otros idiomas. Para información adicional, por favor comuníquese con Servicio al Cliente al 1-866-765-4390.
• Medicare beneficiaries may enroll in WellCare through the CMS Medicare Online Enrollment Center, located at http://www.medicare.gov/.
• Benefits, formulary, pharmacy network, premium and/or co-pays/coinsurance may change on January 1, 2013. Benefits, limitations , co-payments and restrictions may vary by plan and by region. Please contact WellCare for details.
• The person who is discussing plan options with you is either employed by or contracted with WellCare. The person may be paid based on your enrollment in a plan.
• For full information on WellCare prescription drug benefits, current members call WellCare Customer Service at 1-888-550-5252, Monday - Friday, 8am to 2am Eastern. Prospective members call 1-866-765-4390, Monday - Friday, 8am to 2am Eastern. TTY users can call 1-888-816-5252. Or visit us anytime at www.wellcarepdp.com.
• The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). For more information, you can view our plan ratings or visit http://www.medicare.gov/ to compare the plan ratings for Medicare plans in your area. Plan performance summary star ratings are assessed each year and may change from one year to the next.
• You must continue to pay your Medicare Part B premium.
• You may contact 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week or visit http://www.medicare.gov for more information about Medicare benefits and services, including general information regarding the Part D benefit. TTY users can call 1-877-486-2048.
• The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.

S5967_NA016406_PDP_WEB_ENG CMS Approved 10272011