Thank you for selecting EnvisionRx Plus as your Medicare Prescription Drug Plan.
The materials in this section will help you understand how your coverage works and how to use your prescription drug card. Please click on the links below to access each of the following EnvisionRx Plus documents:
Evidence of Coverage (EOC)
Provides a thorough description of your benefits under the EnvisionRx Plus prescription drug card and how to access them.
Silver Plan
- Download EOC (GA, IL, ME, MI, NV, NH, NC, OH, PA, SC, VA, WV)
- Download EOC (CT, DE, DC, MD, MA, NJ, RI, VT)
- Download EOC (FL, IA, MN, MT, NE, NY, ND, SD, WY, CO, NM)
- Download EOC (AL, AZ, AR, CA, ID, IN, KY, LA, MS, MO, OK, OR, TN, UT, WA, WI)
- Download EOC (TX)
- Download EOC (KS)
- Download EOC (HI)
- Download EOC (AK)
Gold Plan
Summary of Benefits
- Download Summary of Benefits (GA, IL, ME, MI, NV, NH, NC, OH, PA, SC, VA, WV)
- Download Summary of Benefits (CT, DE, DC, MD, MA, NJ, RI, VT)
- Download Summary of Benefits (FL, IA, MN, MT, NE, NY, ND, SD, WY, CO, NM)
- Download Summary of Benefits (AL, AZ, AR, CA, ID, IN, KY, LA, MS, MO, OK, OR, TN, UT, WA, WI)
- Download Summary of Benefits (TX)
- Download Summary of Benefits (KS)
- Download Summary of Benefits (HI)
- Download Summary of Benefits (AK)
Plan Transition Process
As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. We will not pay for a transition supply of medications filled at a Mail Order Pharmacy.
If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.
In the event that you enroll in our plan while living at home, and then become a resident of a long term care facility, you need to contact Member Services at 866-250-2005, 7 days a week 24 hours a day and TTY/TDD users should call 866-163-9630 to let EnvisionRx Plus know that you are now a resident of a LTC facility. This will allow us to implement the long term care transition policy for you.
Extra Help
People with limited income and resources may qualify for extra help one of two ways. The amount of extra help you get will depend on your income and resources.
- You automatically qualify for extra help and don’t need to apply. If you have full coverage from a state Medicaid program, get help from Medicaid paying your Medicare premiums (belong to a Medicare Savings Program), or get Supplemental Security Income benefits, you automatically qualify for extra help and do not have to apply for it. Medicare mails a letter to people who automatically qualify for extra help.
- You apply and qualify for extra help. You may qualify if your yearly income in 2008 is less than $15,600 (single with no dependents) or $21,000 (married and living with your spouse with no dependents), and your resources are less than $11,990 (single) or $23,970 (married and living with your spouse). These resource amounts include $1,500 per person for burial expenses. Resources include your savings and stocks but not your home or car.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare of TTY/TDD users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan. View the Extra Help Page and select your State to see what your premium will be.
If you have any questions, please call Member Services at 1-866-250-2005, (TTY/TDD: 1-866-763-9630) 24 hours a day, 7 days a week, 365 days a year.
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