Applicable Conditions and Limitations for Membership
HeartLine Plus is a Medicare Advantage Plan designed to meet all of the needs of South Dakotans suffering from heart-related illnesses. Applicants must reside in South Dakota, have Medicare Part A and Part B; and be diagnosed with Coronary Artery Disease or Heart Failure or have had a Stroke.
Conditions Associated with Receipt or Use of Benefits
Plan members must use network providers. Out-of-network claims will be accepted only for urgent or emergency services within the United States of America.
Service Area
All of South Dakota.
Premiums
HeartLine Plus offers full Medicare Part A and B coverage, Supplemental coverage, and a comprehensive pharmacy benefit (Part D). The full monthly premium for enrollment in HeartLine Plus for the 2008 plan year is $107.00.
NOTE:
Members who qualify for and receive extra help from Medicare will generally have a lower premium. The lower premium amounts for both medical services and prescription drug benefits are as follows:
100% Subsidy - $76.40
75% Subsidy - $84.00
50% Subsidy - $91.70
25% Subsidy - $99.30
* These premiums do not include any Part B Premiums the member may have to pay.
Cost Sharing
HeartLine Plus offers a 3-tiered managed formulary plan through Express Scripts. Under this plan, you pay only the following tier-based co-pays for your Part D prescriptions when you use participating HeartLine Plus pharmacies:
| Tier |
Description |
30 Day Supply |
90 Day Supply
(Mail Order Only) |
| 1 |
Formulary generic drugs |
$5 |
$10 |
| 2 |
Formulary brand name drugs |
$25 |
$50 |
| 3 |
Non-formulary brand name drugs |
$50 |
$100 |
| 4 |
Specialty drugs |
33% coinsurance |
33% coinsurance |
Quality Assurance Policies and Procedures
Medication Therapy Management Program
Beneficiaries' and Plan's Rights and Responsibilities Upon Disenrollment
Evidence of Coverage - Section 11, Page 98
Grievance, Coverage Determinations, Appeals Procedures, and Exceptions Process
Evidence of Coverage - Section 10, Page 81
How to Obtain an Aggregate Number of the Plan's Grievances, Appeals, and Exceptions
Evidence of Coverage - Section 10, Page 81
For clarification or assistance, please call Customer Service at 1-866-437-3288 from 8:00 am to 8:00 pm 7 days a week. TTY users call 711 or 1-800-877-1113.
Pharmacy Access Information
HeartLine Plus has contracts with 173 pharmacies in South Dakota,
exceeding CMS requirements for pharmacy access in your area.
Pharmacy Directory
For pharmacies outside of the State of South Dakota, click here to see page 22 of the pharmacy directory.
This page was last updated on 1/7/2008.
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