Federal Contracting Statement
Stonebridge Life Insurance Company (a Transamerica Company) is a PDP plan sponsor with a Medicare contract. Enrollment in this plan depends on contract renewal.
The service area for this plan includes all states except the state of New York and the U.S. Territories. You must live in one of these areas to join this plan.
The benefit information provided herein is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.
Pharmacy Network Requirement
Members must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply. We also list pharmacies that are in our network but are outside of our plan's service area.
The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients, and customer service). If you have access to the web, you may use the web tools on http://www.medicare.gov/ and select "Health and Drug Plans" then "Compare Drug and Health Plans" to compare the Star Ratings for Medicare plans in your area. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
You are eligible for membership in our plan as long as:
- You live in our geographic service area (all states except the state of New York and the U.S. Territories)
- -- and -- you are entitled to Medicare Part A or you are enrolled in Medicare Part B (or you have both Part A and Part B)
Extra Help Programs
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: 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or Your Medicaid Office.
Medicare beneficiaries may also enroll in Transamerica MedicareRx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov/.
Annual Enrollment Period
The Annual Enrollment Period runs from October 15 through December 7. In general, enrollment is only allowed during the Annual Enrollment Period unless you recently became eligible for Medicare or qualify for a Special Enrollment Period.
Special Enrollment Period
A Special Enrollment Period is when a person, under certain circumstances, may enroll in or disenroll from a Medicare prescription drug plan other than during the Annual Enrollment Period. Examples of such circumstances may include: receiving benefits from both Medicare and Medicaid; changing living situations (such as moving out of state or into a long-term care facility); losing creditable coverage from an employer or other plan sponsor; or losing coverage because a plan no longer offers Medicare prescription drug coverage.
The process of ending your membership in our plan. Disenrollment may be voluntary (your own choice) or involuntary (not your own choice).
Members may disenroll from a prescription drug plan during Medicare's Annual Enrollment Period during a special election period, or to join a 5-Star plan by doing the following:
- Providing a signed written notice to Transamerica MedicareRx, or
- Calling 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, 7 days a week.
Required Involuntary Disenrollment
Our prescription drug plan must disenroll you from our prescription drug plan in the following cases:
- If you do not stay continuously enrolled in Medicare Part A or B (or both).
- If you move out of our service area for more than 12 months.
- If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
- If you continuously behave in a way that is disruptive and makes it difficult for use to provide care for you and other members of our plan (we cannot make you leave the plan for this reason unless we get permission from Medicare first).
- If you let someone else use your membership card to get prescription drugs.
- The individual loses entitlement to Medicare, including if you become incarcerated (go to prison).
- If you die.
- If the prescription drug plan contract is terminated or the Prescription Drug Plan organization stops offering a prescription drug plan in any portion of the area where it had previously been available.
Late Enrollment Penalty
A Late Enrollment Penalty is imposed when a beneficiary fails to maintain creditable prescription coverage for a period of 63 days or more following the last day of an individual's initial enrollment in a Part D plan. Medicare determines the amount of the Late Enrollment Penalty.
As a member of our plan, you pay a monthly plan premium. See your Summary of Benefits and Evidence of Coverage to see your monthly premium for Transamerica MedicareRx. In addition, you must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party), even if the Medicare Part D premium is $0.
In addition to your monthly premium, you will pay an additional amount when drugs are received. Please see your Summary of Benefits and your Evidence of Coverage for information about your cost sharing. Benefits may change on January 1 of every year.
How to Request a Dispute History
You have a right to request the total number of grievances, appeals and exceptions filed with the plan. To request this information, please call Member Services.
Contract Termination Notice
All Medicare prescription drug plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare prescription drug plan leaves the program, you will not lose Medicare coverage. If our plan decides not to continue, we must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area.