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PDP

Q: How can I enroll in WellCare?

A: There are five easy ways to enroll. Choose the one that works best for you.

1. Enroll online. View our plans and complete your application online.
2. Enroll over the phone. Our representatives can enroll you right over the phone. 1-877-236-7162 (TTY 711), during the hours of 8 am and 2 am EST.
3. Enroll at Medicare.gov. Medicare beneficiaries may also enroll in WellCare through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
4. Contact a licensed Medicare Sales Broker. They will be able to walk you through different plans and help you select the one that is best for you.
5. Enroll by mail or fax. Download, print and complete our enrollment form. Return your completed and signed form to us by fax or mail. Use the contact information on the form. EnglishThis PDF document will open in a new window. SpanishThis PDF document will open in a new window.

Q: When can I enroll or make a plan change into a Prescription Drug Plan?

A: Initial Coverage Election Period
The Medicare Initial Coverage Election Period is based on the month of your 65th birthday. You can enroll as early as three months before your birthday month or as late as three months after your birthday month.

Annual Enrollment Period (AEP)
The Medicare Annual Enrollment Period is from October 15 to December 7, during this time you can:

  • Enroll in a Medicare Part D or Medicare Advantage plan from original Medicare
  • Enroll from one Medicare Part D or Medicare Advantage plan to another
  • Enroll in original Medicare from a Medicare Advantage Plan

Changes made to coverage during this time would take effect January 1 of the new plan year.

Medicare Advantage Open Enrollment Period (MA OEP)
The Medicare Advantage Open Enrollment Period starts January 1 and ends on March 31. During this period, members enrolled in Medicare Advantage can:

  • If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage)
  • You can drop your Medicare Advantage Plan and return to Original Medicare. You will also be able to join a Medicare Prescription Drug Plan.

The effective date for the Medicare Advantage Open Enrollment Period election is the first day of the month after we receive the enrollment request.

Special Enrollment Periods (SEP)
You could qualify for a Special Enrollment Period during any month when certain events happen in your life. Reasons you could qualify include:

  • You have changed your permanent residence
  • You have recently moved to a new service area
  • You become eligible for Medicaid
  • You qualify for Extra Help with Medicare prescription drug costs
  • You moved to an institution like a skilled nursing facility or long-term care hospital
  • You want to switch to a plan with a 5-star overall quality rating.

Q: How can I compare WellCare PDP Plans?

A: 1. Visit  www.wellcare.com/PDP
2. Select your state from the drop down
3. Select the “Need a Plan” link towards the bottom of the page
4. Select Prescription Drug Plans in the “I am seeking” page field
5. Enter your ZIP code
6. Select any one of the “Not a Member? Learn about our plans” links
7. Go through the guided steps of the tool

OR
Please check out our plan comparison tool.

Q: Are my prescriptions covered by WellCare?

A: To search for your medications in our online formulary:

1. Visit www.wellcare.com/PDP 
2. Select your state from the drop down
3. Select "Prescription Drug Plan"
4. Enter your ZIP code
5. Find your Plan & select “Go to my plan details”
6. On the right side, select Drug List (Formulary) and search for your medications

Q: What is a Formulary?

A: A formulary lists the drugs your plan covers. If you are working with a licensed sales representative, he or she will have a copy of the formulary and can help you look up the medications you take. You can also find the formulary online at www.wellcare.com/PDP, or request a copy by calling the number on the back of your ID card.

Q: What if I am on a limited income or cannot afford my prescription drugs?

A: The Extra Help program helps people who have limited income and resources to pay Medicare prescription drug program costs. These costs are things like premiums, deductibles and co-payments/co-insurance. Depending on your income and resources, you may qualify for Extra Help.

Find out if you qualify for Extra Help. Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week; TTY users may call 1-877-486-2048. Or apply online at www.ssa.gov/extrahelp, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or contact your state Medicaid Office.

Q: What Pharmacies can I use?

A: To see preferred and standard pharmacies for your PDP plan, please go to our Find a Provider tool. 

1. Select your state from the list of states.
2. Enter your ZIP code and select continue.
3. Select Prescription Drug Plan, select continue.
4. Select your plan from the list of plans, select continue.
5. Select how you want to search, update the distance radius.
6. Type Pharmacy.
7. A list of results will populate, look for the preferred pharmacy indicator for extra savings.

Q: How can I pay my premium?

A: There are five ways you can pay your premium.

1. Electronic Funds Transfer
To get your payments deducted directly from a checking account or savings account:

  • Go to www.wellcare.com/pdp and select the Login/Register button.
  • Select Pay Your Premium to set up payment. Here you can set up “Recurring Payments” as well to allow your premium to come out without having to login every month.

EFT may also set up by downloading an EFT formComplete the form and mail it along with a voided check to the address on the form. English This PDF document will open in a new window. Spanish This PDF document will open in a new window.

2. Your Monthly Social Security or Railroad Retirement Board Check
Call Customer Service (number on the back of your ID card) and we will work directly with Social Security or Railroad Retirement to set up your automatic premium payments.

3. Online or by Phone
You can make single or recurring payments using a bank account, credit card account, or bank card.

  • To pay online: Go to www.wellcare.com/pdp, then click the Login/Register button at the top of the page
  • To pay by phone: Call the Customer Service number listed on your member ID card.

4. Check or Money Order
Make your check or money order payable to WellCare and send to:

WellCare Health Plans, Inc.
PO Box 75510
Chicago, IL 60675-5510

5. Pay with Cash
Use your member ID or payment coupon to pay with cash at CheckFreePay locations. To find a CheckFreePay location near you, call 1-800-877-8021 (TTY 711) or go to www.checkfreepay.com.

Medicare

Q: What is a Medicare Advantage HMO plan?

A: A Medicare Advantage HMO plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A (hospital) and Part B (medical) benefits. It is a health maintenance organization, or HMO. That means it provides care through a network of providers. Care is coordinated through the primary care physician (PCP), who may refer people to specialists as needed. Referrals are generally required to see specialists.

Q: What is a Medicare Advantage HMO POS plan?

A: A Medicare Advantage HMO POS also provides care through a network of providers. However, it includes a point of service (POS) feature, which allows members to receive health care services outside of the network with authorization from the plan, although use of providers within the network is encouraged.

Q: What is a network?

A: A network is a group of doctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with us to deliver covered services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay only your share of the cost for their services.

Q: Where can I get information about basic Medicare terms?

A: We want you to make an informed decision about your Medicare health plan. That’s why we created a glossary to help you understand many commonly used Medicare terms.

Q: Should I still keep my red, white and blue Medicare card?

A: Yes. However, as long as you are a member of our plan you must not use your red, white and blue Medicare card to get covered medical services (with the exception of clinical research studies and hospice services). Keep your red, white and blue Medicare card in a safe place in case you need it later. Here’s why this is so important: If you get covered services using your red, white and blue Medicare card instead of using our membership card while you are a plan member, you may have to pay the full cost yourself. If your 'Ohana ID card is damaged, lost or stolen, contact us right away and we will send you a new card.

Q: If I do not like my 'Ohana plan, can I go back to Original Medicare?

A: Of course. You do not lose your Medicare benefits when you join our plan. However, there are limits on when and how often you can change your Medicare Advantage plan. Contact us to find out more.

Q: When can I enroll or make a plan change into an 'Ohana Medicare Advantage plan?

A: You can enroll or make a plan change into an 'Ohana Plan three months before to three months after the month you turn 65. This is your Initial Coverage Election Period. You can also enroll during the Open Enrollment Period (October 15-December 7 of every year), in which your new coverage would be effective January 1. There are also exceptions throughout the year that may allow you to make plan changes outside of the Open Enrollment Period. Contact us for more information.

Q: How do I start receiving my prescriptions through mail service delivery?

A: You can choose one of three ways to start using CVS/Caremark mail service delivery to fill your prescriptions:

  1. Log onto www.caremark.com/faststart
    • Provide the requested information, and CVS/Caremark will contact your doctor for a 90-day prescription. If you haven’t registered on Caremark.com yet, be sure to have your benefit ID number (BIN) handy when you register for the first time. This number can be found on your WellCare ID card.
    • Call the FastStart® toll-free number: 1-800-875-0867. When you call, be sure to have:
      • The benefit ID number (BIN) from your WellCare ID card
      • Your doctor’s first and last name and phone number
      • Your payment information and mailing address
  2. CVS/Caremark will let you know which prescriptions can be filled through mail service. Your doctor will then be contacted for a 90-day prescription and your medication will be mailed to you.
  3. Fill out and send a mail service order form. Please have the following information with you when you complete the form:
    • The benefit ID number (BIN) from your WellCare ID card
    • Your complete mailing address, including zip code
    • Your doctor’s first and last name and phone number
    • A list of your allergies and other health conditions
    • Your credit or debit card number if you prefer that method of payment. You can also pay by check, electronic check, PayPal Credit or money order (Cash is NOT accepted)
    • Our original prescription from your doctor for up to a 90-day supply

  4. Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.

Q: I'm signed up to get my medications via mail service. How do I order refills?

A: There are 3 ways to refill:

  1. Online. Ordering refills at Caremark.com is convenient, fast and easy! Register online to receive refill reminders and other important updates. Have your benefit ID card handy to register.
  2. By Phone. Call the toll-free Customer Care number on your prescription label for fully automated refill service. Have your benefit ID number (BIN) ready. This number can be found on your WellCare ID Card.
  3. By Mail. You will receive an order form with every mail service order. Simply fill in the ovals for the refills you want to order. If you need a refill for a prescription not listed on the form, write the prescription number in the space provided. Send the form to CVS/Caremark along with your payment.

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.

If you’d like to receive automatic refills and renewals, you can try ReadyFill at Mail®.  Here’s how ReadyFill at Mail works:

  • When you enroll qualified prescriptions in ReadyFill at Mail, CVS/Caremark will automatically refill your prescriptions at the appropriate time, unless you cancel.
  • CVS/Caremark will also contact your doctor to renew your prescription once the last refill is up or the prescription is about to expire.
  • CVS/Caremark will contact you twice before you receive your prescription delivery. The first message is sent by e-mail, phone or text message 14 days before your refill due date to let you know your order is being placed. If you need to cancel the order, you can do so at that time. A second message is sent five to seven days before your refill due date to let you know that your order has shipped.
  • If a copay is required, you will ONLY be charged when your prescription ships.

To enroll in ReadyFill at Mail, register or sign in to www.Caremark.com/ReadyFill, then go to the “Manage Your Prescriptions” page. Select the eligible prescriptions you want to enroll and follow the steps. Or call Customer Care at 1-800-552-8159. They will tell you which prescriptions can be enrolled in ReadyFill at Mail.

Q: How do members get permission to receive services?

A: Members can get service authorizations from their primary care provider (PCP) or from specialists they were referred to by their PCP.

Q: Will I have the same coverage as I do with Original Medicare?

A: Our plans are required to cover all services and procedures that are covered by Original Medicare. However, our plans also offer extra benefits not covered by Original Medicare, which may include routine dental, routine hearing, routine vision and prescription drug coverage. Please note that,  as a member of our plan, your use/participation in a limited number of services, such as clinical research studies and hospice services, will be paid for directly by Medicare. Becoming a member of our plan does not make you ineligible to receive these services.

Q: Can I receive emergency care?

A: You have the right to emergency care, when needed, anywhere in the United States and without pre-approval from us.

Q: Do HMO or HMO POS plans cover services that Medicare does not consider medically necessary?

A: An HMO or HMO POS plan is not required to pay for services that are not medically necessary under Medicare. However, 'Ohana plans do pay for additional benefits not covered by Original Medicare. If you receive a service that is not covered by our plan, you are responsible for the cost of that service. If you are not sure whether a service is covered, you have the right to call us and ask for an advance decision.

Q: What do I need to do to get care?

A: Our plans work just like a traditional health insurance. Just show your 'Ohana Member ID card (instead of your Medicare card) at the doctor's office. You may have a co-payment due at that time.

Q: What happens if my doctor is not familiar with 'Ohana plans?

A: If your doctor or health care provider would like more information about 'Ohana, ask him or her to contact us. Our Customer Service representatives are ready to answer questions.

Q: Can 'Ohana ever drop my coverage?

A: Once you are enrolled, you cannot be disqualified for any medical condition. However, if you move out of our service area or commit fraud, 'Ohana reserves the right to disenroll you. All Medicare Advantage plans commit to their members for a full year. Each year, 'Ohana decides whether to continue a plan for another year. Even if a Medicare Advantage Plan is discontinued at the end of a benefit year, you will not lose Medicare coverage. If your plan is discontinued, 'Ohana must notify you in writing at least 60 days before your coverage ends. The letter will explain your other options for Medicare coverage in your area.

Q: What if I need to talk to a nurse?

A: One of the perks of being an 'Ohana member is our 24-hour Nurse Advice Line.

Nurse Advice Line: 1-800-919-8807
Nurse Advice Line - TTY: 711
24 hours a day, 7 days a week

Our nurses will give you answers to your medical questions and help you decide whether or not to see your doctor or go to the emergency room. Nurses are available 24 hours a day, 7 days a week. You can also find the number on the back of your Member ID card.

Q: Do I still have to pay my Medicare Part B premium?

A: Yes. When you join an 'Ohana plan, you must continue to pay your Medicare Part B premium unless it's paid for you by Medicaid or another third party. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premium may be covered in full.

Medicaid

Q: What is Medicaid?

A: Medicaid provides medical coverage to low-income individuals and families. The state and federal government share the cost of the Medicaid program.

Q: How do I know if I qualify?

A: Medicaid eligibility is determined either by the State of Hawai'i or the Social Security Administration (for SSI recipients).

Q: How do I apply for assistance?

A: Individuals may apply for assistance online at the State of Hawai'i website.

Q: Which hospitals are in the 'Ohana network?

A: Your provider directory has a listing of all hospitals in your health plan network. Your primary care physician or specialist will coordinate your hospital care.

Q: How do I get a provider directory?

A: You can request a copy of a provider directory by contacting our Customer Service Department. Alternatively, you may use the Find a Provider feature to view a listing of providers in your area.

Q: What if I have an emergency?

A: In an emergency, please dial 911 or proceed to the nearest medical facility. Call your primary care physician or our Customer Service Department as soon as possible after the emergency, to ensure that we are aware of your situation and can assist you to receive appropriate follow-up care.

Q: I forgot my password/username/am having trouble logging in. What do I do?

A: Use the Contact Us form. .You can also call the Customer Service number on the back of your card if you have one.

Q: I am moving to a new address. What should I do?

A: To provide you with important information about your health plan promptly, it is crucial that we have your most current address and contact information on file. If you are moving, please update your records by submitting the Change of Address form available in your member handbook, or call the Customer Service department with your new address. You can also use the Contact Us form.

Provider

Q: How do I join 'Ohana?

A: Please complete our Become a Provider form or contact us for more information on how to join our network. If you want to join our Medicaid provider network, please be sure to visit your state-specific Medicaid website to submit a request.

Q: I forgot my Provider ID number. Where can I find it?

A: Please check your 'Ohana welcome letter. You can also use the Contact Us form for additional help.

Q: How do I check the status of a claim?

A: You must log in to the secure portal:

Here are the steps to check a claim status:

How to Check a Claim Status

Step 1

Under Find by, select your search criteria by Provider ID, Member ID or Claim Number.

Step 2

In the Member | Provider ID | Claim Number box (depending on the option chosen above), type the appropriate number.

Click Lookup Provider ID, if you do not know the ID number.

Step 3

Under Dates, select Date of Service and enter the desired date range.

OR

Select a date range from the Within drop-down box.
(Last day, Last 2 days, Last week, Last 2 weeks, or Last month)

Step 4

Click the Check Claim Status button.

The claim results are displayed at the bottom of the screen.

Q: Does 'Ohana provide Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) services?

A: Yes. 'Ohana Health Plan is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Offered in partnership with PaySpan Health, you now have access to a secure, quick way to electronically settle claims. Using this no-cost service, providers can settle claims electronically, without making an investment in expensive EDI software.

Producer

Q: How do I become an 'Ohana producer?

A: All new agents interested in marketing 'Ohana Health Plan must complete an online contract. The first step is to email and provide the following information:

  • First name
  • Last name
  • Phone number
  • Email address
  • National Producer Number (NPN)
  • Product: Medicare Advantage or PDP
  • States you are marketing in
You will receive an email from Producer Services with more information and documents to sign. Follow the subsequent instructions provided.

Q: How do I get information about company health plans?

A: Go to our Producer section of the website.

Q: What if I need additional assistance or have questions?

A: We ask that you contact your local District Sales Manager as your direct line of support. These managers are familiar with your particular area and are best suited to support you on a local level with anything from supplies and training questions to enrollment and commission issues. If you have any questions or need assistance, please contact your local District Sales Manager This PDF document will open in a new window..

Corporate

Q: How does WellCare get involved in the local community?

A: Watch the videos and see why we are so passionate about serving our members and the communities in which they live!

Video: A Mission To Serve - WellCare Health Plans 

Q: How can I find out if WellCare is hiring?

A: Visit our Careers page to see current openings.

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Last Updated On: 3/12/2021