Disclaimers

Elderplan FIDA Total Care is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.

Limitations and restrictions may apply. For more information, call Elderplan FIDA Total Care Participant Services or read the Elderplan FIDA Total Care participant handbook. Benefits, list of covered drugs, and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year.

You can get this information for free in other formats, such as Braille or large print. Call 1-855-462-3167. TTY users should call 711. The call is free.

You can get this information for free in other languages. Call 855-462-3167 and 711 for TTY/TDD users between 8:00 a.m. and 8:00 p.m., 7 days a week. The call is free.

Puede obtener esta información de manera gratuita en otros idiomas. Llame al 1-855-462-3167 y TTY/TDD 711 de lunes a domingos de 8:00 a.m. a 8:00 p.m. La llamada es gratuita.

Ou ka jwenn enfòmasyon sa a gratis nan lòt lang. Rele nan 1-855-462-3167 ak nan TTY/TDD (pou moun ki gen pwoblèm tande oswa moun ki bèbè) 711 de lendi a dimanch 8:00 a.m. – 8:00 p.m. Apèl la gratis.

이정보는다른언어로도제공됩니다(무료). 월요일-일요일8:00 a.m. – 8:00 p.m. 중 1-855-462-3167 나 TTY/TDD 711 로전화주십시오. 통화료는무료입니다.

您可免費取得以其他語言撰寫的資訊。請於週一至週日上午8 時至下午8時致 電1-855-462-3167,TTY/TDD 使用者:711。此為免付費電話。

Данная информация доступна бесплатно на других языках. Звоните по номеру 1-855-462-3167 или 711 (линия TTY/TDD) с понедельника по воскресенье с 8:00 до 20:00. Звонок бесплатный.

È possibile riceverequeste informazioni in altre lingue gratuitamente. Contatta il 1-855-462-3167 eTTY/TDD 711 dal lunedì alla domenica dalle ore 8:00 alle ore 20:00. Il servizio è gratuito.

For information on Elderplan FIDA Total Care (Medicare-Medicaid Plan), contact Elderplan or the New York Enrollment Broker. To enroll or for other options for your health care, call the New York Enrollment Broker at 1-855-600-FIDA (TTY: 1-888-329-1541 for the hearing impaired) from 8:30 a.m. to 8:00 p.m. Monday through Friday and from 10:00 a.m. to 6:00 p.m. on Saturday, or visit www.nymedicaidchoice.com.

The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by Elderplan FIDA Total Care (Medicare-Medicaid Plan). ICAN may be reached toll-free at 1-844-614-8800 or online at www.icannys.org.

Elderplan FIDA Total Care has a Model of Care approved by the National Committee for Quality Assurance (NCQA) and the New York State Department of Health until 12/31/2018 based on a review of Elderplan FIDA Total Care’s Model of Care.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Participant Handbook.

Participants must receive all routine care from plan providers.

Authorization rules may apply for certain services. Limitations, co-payments and restrictions may apply.

Elderplan’s Medicare Prescription Drug benefit is only available to enrolled participants. If a beneficiary is already enrolled in a Medicare Advantage Part D (MA-PD) Plan, the enrollee must receive his/her Medicare Prescription Drug benefit through that plan.

Elderplan renews its contract with the Centers for Medicare and Medicaid Services (CMS) annually. Benefits beyond the current contract year are not guaranteed.

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 Participant Services Department at 1-855-462-3167. TTY users should call 711, between 8 a.m. – 8 p.m., 7 days a week. Information may also be obtained by writing Elderplan, Attention: Participant 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.

ATTENTION: If you speak a non-English language or require assistance in ASL, language assistance services, free of charge, are available to you. Call 1-855-462-3167 (TTY: 711).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-462-3167 (TTY: 711).

注意: 如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-855-462-3167 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-855-462-3167 (телетайп: 711).

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-855-462-3167 (TTY: 711).

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-855-462-3167 (TTY: 711) 번으로 전화해 주십시오.

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-855-462-3167 (TTY: 711).

אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. רופט (1-855-462-3167 TTY: 711).

লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। ফোন করুন 1-855-462-3167 (TTY: 711).

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-855-462-3167 (TTY: 711).

ملحوظة:    إذا كنت تتحدث لغة غير الإنجليزية أو تحتاج إلى مساعدة في ASL، فإن خدمات المساعدة اللغوية تتوافر لك مجانا.  اتصل (1-855-462-3167 TTY: 711).

ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-855-462-3167 (ATS: 711).

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں (1-855-462-3167 TTY: 711).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-462-3167 (TTY: 711).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-855-462-3167 (TTY: 711).

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-855-462-3167 (TTY: 711).