Provider Newsletter

Last Updated: 09/18/2017

Helpful Links	Hours	Telephone
CMS Model Electronic Complaint Form	8am to 8pm 7 days a week October 1st to February 14th	Toll Free: 1-866-245-5360
The Medicare Beneficiary Ombudsman	8am to 8pm Mon. - Fri. February 15th to September 30th	TTY/TDD: 711
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Benefits During Disasters and Catastrophic Events
Click here for Multi-Language Interpreter Services (Multi-Language Insert)
Section 1557 Notice of Non-Discrimination English Spanish

Website Disclaimer

Optimum HealthCare, Inc. is an HMO plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Optimum HealthCare, Inc. depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Beneficiaries generally must use network pharmacies to access their prescription drug benefit. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Optimum HealthCare through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Depending on the services, a prior authorization or referral from your doctor may be required.

For Chronic Special Needs Plans (SNP): These plans are available to anyone who has been diagnosed with Diabetes, Cardiovascular Disease, Chronic Heart Failure, or a qualified Chronic Lung Disorder, such as Chronic Obstructive Pulmonary Disease (COPD), Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, or Pulmonary Hypertension.

For Dual Special Needs Plans (DSNP): These plans are available to anyone who has both medical assistance from the state and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Part B premium is covered for full dual members of Special Needs Plans.

This information is available for free in other languages. Please call our Member Services number at 1-866-245-5360 for additional information. TTY/TDD users should call 711. Hours are October 1 to February 14 from 8 a.m. to 8 p.m. 7 days a week and February 15 to September 30 from 8 a.m. to 8 p.m. Monday through Friday. Member Services also provides free language interpreter services for non-English speakers.

Optimum HealthCare, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-245-5360 (TTY: 711). Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-245-5360 (TTY: 711).

Esta información está disponible gratis en otros idiomas. Por favor llame a nuestro número de Servicio de Miembros al 1-866-245-5360 (TTY 711) para obtener información adicional. Las horas de operación son del 1 de octubre al 14 de febrero de 8 a.m. a 8 p.m. los 7 días a la semana y del 15 de febrero al 30 de septiembre de 8 a.m. a 8 p.m. de lunes a viernes. Servicios de Miembros también ofrece servicios de interpretación de idiomas gratis para personas que no hablan inglés.

Optimum HealthCare, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-245-5360 (TTY: 711). Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-245-5360 (TTY: 711).

These materials may be made available in alternate formats (e.g., large print, Braille) to individuals with disabilities, upon request.

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