Doctors HealthCare Plans, Inc. Your Health, Our Commitment
 2020 Ponce de Leon Blvd, Suite PH 1, Coral Gables, FL 33134   
  

Other Important Information

Information on Receiving Extra Help and Savings Benefits

Did you know you could qualify for extra help and savings benefits?

Medicare Savings Programs These are state programs that assist individuals with limited income in paying with their Medicare costs. The names of these programs may vary by state. The state can help individuals paying for Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance and copayments if certain conditions are met.

Low Income Subsidy (LIS) – A program to help individuals pay for Medicare Prescription Drug costs, that it is also called “Extra Help”. Medicare beneficiaries receiving LIS may be able to qualify for assistance in paying for their Part D monthly premium, annual deductible, coinsurance and copayments. The amount of subsidy depends on the individual’s income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.

Doctors HealthCare Plans LIS Premium Summary Table 2020

Monthly Premium for the Plans

This does not include any Medicare Part B premium you may have to pay.


Doctors HealthCare Plans LIS Premium Summary Table 2021

This does not include any Medicare Part B premium you may have to pay.

For more information and to see if you qualify you may call our Social Services Team at 786-866-4546, TTY users should call 711. We are open Monday through Friday, 9 a.m. – 5 p.m.  Our Social Services Department can provide you with important eligibility information and help you apply for public assistance at no cost to you.  Review our informational brochure below:

Social Services Brochure – English

Social Services Brochure – Spanish

 

 

 

Doctors HealthCare Plans is proud to be a member of the ACCESS Florida Community Network

Centers for Medicare & Medicaid Services
Website: www.medicare.gov
Toll-free phone: 1-800-633-4227
TTY: 1-877-486-2048
24 hours a day, seven days a week

Social Security Administration
Website: http://www.socialsecurity.gov/prescriptionhelp
Toll-free phone: 1-800-772-1213
TTY: 1-800-325-0778
Monday through Friday 7 a.m. to 7 p.m.

Department of Children and Families (DCF)
Florida Partner Website at www.myflorida.com/accessflorida

Phone: 1-866-762-2237
TTY users should call 1-800-955-8771 or 1-800-955-8770

Best Available Evidence

Doctors HealthCare Plans must accept certain forms of evidence of Extra Help or Low Income Subsidy (LIS) assistance when our system or CMS’ system does not indicate that you are eligible for this assistance. The Best Available Evidence page on the CMS website gives examples of the information you should provide to us.  https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Best_Available_Evidence_Policy.html

Doctors HealthCare Plans Quality Improvement and Management

Doctors HealthCare Plans, Inc. (the Plan), continually strives to improve quality of care and services for our Members.  For more information please see below:

Quality Improvement and Management English / Spanish

Special Needs Plans (SNP) Quality Improvement Performance Results – DrPlus (HMO-POS SNP), DrCare (HMO-POS SNP), DrExtra (HMO- POS SNP)

Doctors HealthCare Plans performs annual evaluation of its Model of Care. Please call us for details related to this evaluation, at the Member Services telephone number on the back of your ID card – Member Services: Local: 786-460-3427 Toll-Free: 1-833-342-7463 TTY 711. We are open 7 days a week, 8:00 a.m. to 8:00 p.m.

DrPlus (HMO-POS SNP), DrCare (HMO-POS SNP), DrExtra (HMO- POS SNP) have been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2021 based on a review of Model of Care (MOC). DrPlus (HMO POS SNP) is sponsored by Doctors HealthCare Plans, Inc. and the State of Florida Agency for Health Care Administration.

CMS Transmittals

Program transmittals are issued by The Centers for Medicare & Medicaid Services (CMS)  to communicate new or changed policies and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal) summarizes the new material, specifying what has changed. CMS has developed MLN Matters® bulletins that provide Medicare coverage and reimbursement rules in a brief and easy-to-understand format.  Please visit the CMS website using the following links:

CMS Transmittals 

MLN Matters articles  

National Coverage Determinations (NCD)

National Coverage Determinations (NCDs) are binding on all Medicare contractors, quality improvement organizations and health maintenance organizations. From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.

National Coverage Determinations (NCD)

Doctors HealthCare Plans Member Rights and Responsibilities

As a Doctors HealthCare Plans Member, you are afforded certain rights, responsibilities, and protections. The following summary of your Member Rights and Responsibilities is provided for your information. This does not alter or amend your health care coverage with Doctors HealthCare Plans, Inc. and we do encourage you to become familiar with them and welcome any questions or further assistance we may provide.

Member Rights and Responsibilities English / Spanish

Agency for Health Care Administration Rules and Services

The Agency for Health Care Administration (AHCA) is responsible for the administration of the Florida Medicaid program.   Below is the AHCA website address. The site contains rules and services specific policies.  Please use this as a resource to better understand Medicaid benefits and services.

http://ahca.myflorida.com/medicaid/review/specific_policy.shtml

Florida Division of Emergency Management

Below is the Florida Division of Emergency Management website.  This site provides important information regarding disasters and how to prepare and mitigate against impact. Please use this resource to plan and prepare.

https://floridadisaster.org/info/

 

 

 

H4140_DHCPMSOther_C
Last Updated: 10/15/2020

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