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.
Summary of Benefits
Plan Transition Process
As a new member in our plan you may be taking medications that are not on our formulary. In this case, you should ask your doctor to determine if there is an appropriate formulary medication that can be substituted. If your doctor determines that there is no formulary medication that can be substituted for your current therapy, you may request a formulary exception (a request for coverage of a non-formulary medication). While you and your doctor are determining the right course of action for you, we have the following policy in place to ensure that you are not left without medication coverage.
New Members to Envision
Within the first 90 days of coverage with EIC, we will provide new members a one-time temporary fill for at least 30 day supply of non-formulary medication (unless the prescription is written for fewer days). LTC Members
Within the first 90 days of coverage with EIC, a new EIC enrollee residing in a Long Term Care (LTC) facility will be provided a temporary supply of non-formulary medications. The temporary supply will be for up to 31 days (unless the prescription is written for less than 31 days). In addition, EIC will honor multiple fills of non-formulary medications, for up to a 93 day supply within the first 90 days of coverage. Transition Across Plan Years
The list of covered formulary medications is subject to change from year. For this reason, we have a transition policy in place for current EIC members who are taking a medication that will not be covered in the next plan year. In the first 90 days of the plan year, EIC will provide a temporary supply of the requested non-formulary prescription drug when the member has had a prescription for the medication filled within the past 120 days. EIC will mail enrollees a transition notice that they must either switch to a drug on the applicable EIC formulary or get an exception to continue taking the non-formulary medication. Emergency Transitions
If you are past your 90-day transition period, we may still provide to you an emergency supply of non-formulary medications. This will occur on a case by case basis, when it has been identified that an exception request or appeal has been filed but it has not been completed by the end of the transition period.
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 users should call 866-763-9630 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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