Welcome to Dean Health Plan - 2022 Medicare New Member Guide
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2022 Medicare
New Member Guide
Welcome to
Dean Health Plan
Getting Started
Extra Benefits
Using Your Plan
Plan Details
Contents
Welcome 3 Using Your Plan
Getting Started Prescription Drug Coverage 18
Member Checklist 4 Preventive Care 22
Tools and Resources 6 Diabetes Benefits 24
Extra Benefits Prior Authorization 26
Silver&Fit® 8 Plan Details
Papa Pals Assistance Extra 9 Your Rights and Responsibilities 27
Delta Dental Benefits 10 Grievance and Appeals 27
Lyft Transportation 12 Limitations and Exclusions 27
Living Healthy 14 Non-Discrimination Notice 28
Getting the Right Care 16 Language Assistance 29
Appointment Tips 17
You have opinions. The Customer Care
We listen. Center is Here to Help!
Call our knowledgeable Medicare
We care how you feel about us Specialists to get answers to your
and we’re listening. You’re invited health plan coverage questions.
to join our online forum to express
your thoughts about how we can
continue delivering an exceptional Toll-free
experience in all that we do. CALL 877-232-7566 (TTY: 711)
Local
Just visit ssmhealthlistens.com 608-828-1978 (TTY: 711)
to sign up.
Visit For more information
CLICK on membership visit
deancare.com/
medicareadvantagemembers
Keep the attached magnet on your
refrigerator for easy reference.
2 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health Plan
Welcome to
Dean Health Plan
Dean Medicare Advantage Plans
• Essential (HMO)
• Assurance (HMO-POS) | SSM Presence (HMO-POS)
• Balance (HMO-POS)
• Complete (HMO)
• Harmony (HMO-POS MA-Only)
Quality matters. Our Medicare
Advantage achievements show
our commitment to providing
high-quality care and services to you.
To learn about our quality efforts
visit deancare.com/quality
The Home Team Advantage Coordinated Network
At Dean Health Plan, a member of
SSM Health, you’ll find your primary care
provider (PCP) working together with a
whole Care Team of nurses, pharmacists,
case managers, social workers and others
who know you and your specific medical
needs. They collaborate to guide you
to health resources within our system, Physicians Health Plan
including nutrition services, pharmacy Member Coverage
needs, community programs and more.
Turn to your Care Team –
that’s the Dean Advantage.
Hospitals
Service Area
The service area and provider network for Dean Advantage plans
include: Wisconsin’s Columbia, Dane, Dodge, Fond Du Lac, Green, Iowa,
Jefferson, Rock and Sauk counties.
deancare.com/medicareadvantagemembers | 3
Getting Started To find out more information…
visit deancare.com/
Member Checklist medicareadvantagemembers
We encourage you to complete this
checklist to take advantage of the
benefits and services available to
you as a Dean Advantage member.
Schedule your $0 Annual Wellness Review Your Benefits
Visit and $0 Annual Physical Exam Make sure you understand your health plan
You’ll want to make an appointment to see benefits, including limitations and exclusions.
your doctor so they can learn more about you Find information in Chapter 4 of your
and how to best care for you. Evidence of Coverage, which can be found
in the Member Portal or at deancare.com/
Transfer Your Medical Records medicareadvantagemember
(For members new to SSM Clinics)
Review Your Drugs*
Once you’ve scheduled an appointment with
your new doctor, you should transfer your Check to make sure your medications are
medical records from your previous clinic on the formulary and see which preferred
to your new clinic. Contact your previous network location is near you. Go to
clinic to complete an authorization to release deancare.com/medicareadvantagemember
protected health information so your new to see our formulary and pharmacy network.
doctor knows about your previous health
conditions and medical treatments to better Enroll in the Papa Program
meet your medical needs. You will receive a phone call from Papa to be
part of the Papa Pals Program, if interested.
Complete Your Health See page 9 for more information on the Papa
Assessment Survey Program. You can also call Papa directly at
Complete the short health assessment survey 888-840-1609 to enroll.
enclosed in this kit. This survey helps us
provide you more personalized health care.
* This does not apply to member on the Harmony plan, which does not include drug coverage.
4 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health Plan
Tell Us If You Have Other Create a Member Portal Account
Health Insurance Your member portal provides secure access
If you have more than one health insurance to information about your health insurance
policy for your medical care, please contact benefits, access to make premium payments,
the Customer Care Center to let us know. We view claims information and more.
will help you determine how your other health
insurance works together with your Medicare Create a MyChart Account
Advantage plan.
MyChart gives you secure access to your
health information. Use this portal to make
Complete the Automatic Withdrawal appointments, message your provider, view
Payment Form lab results and more.
This form ensures you never miss a payment.
Completing the form will allow your premium
payments to be automatically withdrawn
from your bank account of choice.
Complete the Appointment
of Representative Form
This form ensures that your authorized
representative can speak with Dean Health
Plan on your behalf.
deancare.com/medicareadvantagemembers | 5
Getting Started Find helpful tools and information…
To activate your member portal
Take Advantage account and sign up for MyChart
visit deancare.com/login
of Tools
and Resources
What you need, when you need it. Visit deancare.com/medicareadvantage
We want to take the stress out of finding members to discover helpful tools that
the information you need to manage provide easy access to your coverage
your health care and coverage. information, benefit details and answers to
questions you might have along the way.
Your Online Member Portal
Access your plan information any time. 3. Enter your account
Discover a helpful tool that provides easy access information:
to your coverage information. Access current
portal features: a. Enter your first
and last name
• View Personal Information as shown on
your Member ID Card
• Order Member ID Card
b. Enter a valid email address
• Download Member Benefit
Documents 4. Following the password requirements,
create and confirm your password
• View Claims and Claim Details
5. Complete the Multi-factor Authentication
• Direct Access to Pharmacy
Information process by:
• Direct Link to Living Healthy a. Selecting either text or call verification
• Pay Premium b. Enter your phone number and click
“Request Code”
c. The code will be sent to your phone.
Once you receive your code, enter it in the
To Sign Up “Verification Code” box, click on “Verify
You may only register for the Member Portal Code” and then on “Continue”
on or after the effective date of your Dean 6. Complete the “Member Details” page using
Advantage policy. the information from your ID card
You will need your Member ID card to activate
7. Read the “Terms and Conditions” and when
your member portal account.
finished click on “Accept Terms & Conditions”
1. Navigate to member.deancare.com and then click “Continue”
2 Click on “Create Account” 8. The “Registration Complete” screen will
appear, letting you know your registration
was successful.
6 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health Plan
Your Online Health Record
Access your health information any time.
MyChart is a free service for SSM patients,
providing online access to information in your
personal and family health records. MyChart
deancare.com/login or the MyChart app*.
With MyChart, you can:
• Communicate with a physician and health
care team through secure messaging
• Get answers to your medical questions
from the comfort of your own home
• Get real time lab and test results –
Common Questions no more waiting for a phone call or
letter – view your results and your
I forgot my password. doctor’s comments within days
How do I find out what it is?
• Request a prescription refill from
Click Login to member portal and
your doctor
select “Forgot your password?” to
choose a new password. • View current medical records
• Manage your appointments – schedule your
I forgot my User ID. next appointment, or view details of your
How do I find out what it is? past and upcoming appointments
IMPORTANT: Store your user ID in a
handy place so you can easily access it • Pay medical bills online
when you need to login. If you forget
your user ID, you will have to create Sign Up for MyChart in Three Easy Steps:
a new account and re-register your
account to access your information. 1. Sign up at deancare.com/login
2. Under the MyChart section, select “MYCHART
Who can I contact if I’m having LOGIN” and then “Sign Up Now” under the
issues or questions about the “New User?” section to enroll. Complete the
member portal? online form and activate your account today.
Please call Dean Advantage If you need help, call MyChart support at
the Customer Care Center at 888-521-3326.
877-232-7566 (TTY: 711),
8 am to 8 pm (year-round) and 3. Activate your account.
weekends (Oct. 1 - Mar. 31).
*Ask your clinic if MyChart or another secure messaging
system is available.
deancare.com/medicareadvantagemembers | 7
Getting Started Learn more at...
Find more information about our extra
Extra Benefits benefits at deancare.com/extrabenefits
Not Covered by
Original Medicare
Our Medicare Advantage benefits
support healthy aging. They are
designed to help you stay active,
manage your emotional wellbeing
and make good health a priority.
Stay Active
Fitness Living Healthy Rewards
The Silver&Fit® program includes: You can earn up to $150 in
gift cards as a reward for
• Fitness Center Membership: You
completing healthy activities.
can visit participating fitness
centers or YMCAs near you that Here’s how it works:
take part in the program.
• Choose the healthy activities you want
• Home Fitness Kit: There are a variety of to complete.
home fitness kits to choose from. You can
• Each completed activity is worth reward
select one home fitness kit with Fitbit,
points (example: 500 points = $50)
Garmin or other exercise equipment per year.
• Earn up to 1,500 points for a maximum
• Get Started Program: By answering a few
of $150 per calendar year (before
online questions about your areas of interest,
December 31, 2022)
you will receive a customized program
for your exercise of choice, including • Rewards come in the form of gift card(s)
instructions on how to get started and of your choice to many national retailers,
suggested online workout videos. restaurants and other popular merchants.
• 8,000+ on-demand videos through • You must enter and redeem all points by
the website and mobile app digital December 31, 2022 to be eligible for rewards.
library, including the Silver&Fit Log into the Member Portal to access Living
Signature Series Classes®. Healthy Rewards. See page 6 for more directions
• The Silver&Fit Connected™ tool on the member portal.
for tracking your activity.
• Online Healthy Aging classes.
• Online quarterly newsletter.
Go to SilverandFit.com to register for
the program. It’s quick and easy!
8 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health Plan
Manage Your Emotional Wellbeing
In-Home Support
We partnered with Papa, a We cover 10 hours per month of Papa
company that connects you with services. Pals can support you either in your
screened and trained Papa Pals. home or virtually. Enroll with Papa by calling
Pals provide assistance with 888-840-1609.
organization, light housework,
technology and transportation.
This includes:
• Household Tasks: Pals help around the house
with light cleaning, organization, laundry,
cooking/meal prep, and taking care of pets.
• Technology Help: Pals teach you how to use
a computer, smart phone, and tablet. This
includes assistance with using social media,
accessing a telehealth provider, starting a
video chat with loved ones and accessing
health plan resources online.
• Transportation: Pals assist you with
transportation to doctor appointments,
grocery/pharmacy shopping and other
errands. Pals will pick you up at home, take
you to the store/appointment, bring you
back home, and help you carry bags into
the home.
deancare.com/medicareadvantagemembers | 9
Getting Started Learn more at...
Find more information about our extra
Extra Benefits benefits at deancare.com/extrabenefits
Not Covered by
Original Medicare (continued)
Dean Health Plan is dedicated
to our members’ well-being.
Make Good Health a Priority
$0 Primary Care Visits Dental
We cover all visits with a primary We cover both preventive and
care provider at $0. This includes comprehensive dental benefits
in person visits and telehealth. through our partner Delta Dental.
Our plan has no waiting period, no
deductibles or coinsurance.
Benefits include:
• Preventive and diagnostic services: $0 copay
• Gum disease maintenance and bridge/
implants/dentures repairs: $45 copay
• Fillings, non-surgical gum disease treatment
and extractions: $95 copay
• Root canals, bridges, implants, dentures,
crowns and surgical gum disease
procedures: $595 copay
• We cover $1,500 in dental services per year
Members with cancer-related treatments,
weakened immune systems, periodontal disease,
high-risk cardiac conditions, kidney failure and
diabetes may be eligible for up to 2 additional
cleanings and 1 additional fluoride treatment
every calendar year.
See deancare.com/extrabenefits to search
the dental directory and see a full list of
covered procedures.
10 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanOver-the-Counter Allowance
We cover $50 quarterly to be used You can shop:
towards the purchase of eligible • In-store at participating retailers including
over-the-counter (OTC) health and some SSM Health Pharmacies, Walgreens,
wellness products. This benefit CVS, Walmart, Dollar General and
is available at the beginning of Kroger stores
each quarter (January, April, July,
• Online at OTCNetwork.com
October). Unused dollars will not
carry forward to the next quarter. • Mail-order catalog
After you receive your OTC card in the mail, visit
Your OTC card can be used to purchase OTCNetwork.com or download the OTC app to
items such as: see the list of all participating retailers, a full list
• Vitamins and minerals of covered items and to check your card balance.
• Heart health and essential fatty acids
(fish oil, flax, GLA, etc.)
• Adult aspirin and pain relief
• Allergy, sinus and combo liquids and tablets
• Cough, cold and flu liquids or tablets
• Digestive aids (probiotics and prebiotics)
• Incontinence products
• Oral care
• Acid controller liquids/tablets
• Laxatives (stool softeners and fiber acid)
• Ear drops and eye wash
deancare.com/medicareadvantagemembers | 11Getting Started Learn more at...
Find more information about our extra
Extra Benefits benefits at deancare.com/extrabenefits
Not Covered by
Original Medicare (continued)
Ways to Promote Healthy Aging:
Staying Active
Emotional Well-being
Good Health
Make Good Health a Priority (continued)
Transportation Vision Exam and Eyewear
We partnered with Lyft to cover We cover one $0 routine vision
24 one-way personal rides each exam and a $200 eyewear
year to medical appointments allowance per year at our in-
and to the pharmacy. Contact network eyeglass providers.
the Customer Care Center at Find an in-network
least three business days in eyeglass provider at
advance if you would like a ride deancare.com/locations
to an upcoming appointment.
Making life easier to get to your
appointments! Hearing Exam and
Hearing Aids
Post-Discharge Meals We cover one $0 routine hearing
exam and a $750 hearing aid
If you are discharged from the allowance per year at in-network
hospital or skilled nursing facility, hearing aid providers.
you are eligible to receive 14
meals delivered to your door. Find an in-network
If meals are not coordinated hearing aid provider at
through your care manager as deancare.com/locations
part of discharge planning, reach
out to the Customer Care Center
to access the Moms Meals benefit.
We’re here to help!
12 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanRoutine Footcare Virtual Care
We cover 10 routine footcare With an SSM Health E-Visit you
visits every calendar year. This can get a diagnosis, a treatment
includes treatment of the foot plan, and a prescription if needed
which is generally considered for common conditions like upper
preventive, i.e., cutting or respiratory infection or allergies,
removal of corns, warts, calluses urinary tract infections, tick bites
or nails. You pay your plan’s and skin problems from anywhere
specialist copay for routine in Wisconsin at any time. See
footcare services. conditions treated and complete
an online health interview. An
SSM Health provider will respond
Routine Chiropractic
within 1 hour during office hours,
We cover 12 routine chiropractic or first thing the next morning if
visits every calendar year. after hours.
Depending on your plan, you
pay $10 or $15 copay per visit
for routine chiropractic services.
Find an in-network provider at
deancare.com/doctors
deancare.com/medicareadvantagemembers | 13Getting Started
Be A
Healthier You
Your comprehensive wellness program
Dean Health Plan in partnership with WebMD offers
a variety of programs focusing on the whole person
across eight dimensions of wellness, making healthy
living achievable and fun.
Wellness Programs and Features
Health Assessment
Based on your individual questionnaire results,
WebMD provides recommendations for each lifestyle
category. A variety of interactive self-management
tools are customized to your needs.
Case Management Your lowest risks are…
Provides support through complex health situations.
Fitness Emotional Tobacco Cervical
The Silver&Fit® program includes fitness center Health Cancer
Screening
memberships, home fitness kit with exercise
equipment, 8,000+ on-demand videos and more.
You should work on…
Tobacco Cessation
Tobacco cessation and vape free programs
for families.
Blood Stress Safety
Pressure
R.E.A.L. Goals (Realistic, Easy, Attainable, Life Goals)
Preset goals covering all eight dimensions along with
tips and trackers to help you achieve success. Optimal YOU is 100
You scored a 41 out of 100
Wellness Webinars
Covering all eight dimensions, available 24/7.
100
Health Assessment Example
Earn up to $150 in rewards!
14 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanQuestions about Living Healthy Rewards?
Visit deancare.com/rewards to learn
how to redeem reward points through
Living Healthy your Living Healthy portal.
Rewards
Your rewards. Your choice.
Earn up to $150* in rewards! Living Healthy Rewards 2022 will
focus on Preventive Health Services!
Dean Health Plan will reward you up to $150*
for your healthy lifestyle. It’s one of the many Prevention or early detection of common
reasons Living Healthy has its rewards! diseases is the best way to be the
healthiest you. The list below includes
Here’s how it works: some of the more common preventive
Choose the healthy activities and screening services proven to improve
you want to complete health, but it is important to check with
your primary care provider to determine
which tests are appropriate for you, based
on your medical history and family history.
Each completed activity
Earn points for taking care of you!
Points is worth reward points
500 (example: 500 points = $50)
Immunizations:
Influenza, Varicella, Tetanus,
Earn up to 1,500 points Meningococcal and
for a maximum of $150* Pneumococcal
per calendar year
(before December 31)
Cancer screenings:
Rewards come in the form Mammogram, Colon Cancer
of gift card(s) of your (FIT testing, Cologuard,
choice to many national Colonoscopy) and PAP
retailers, restaurants and smear
other popular merchants
Other screenings:
Chlamydia, Gonorrhea,
All rewards MUST be redeemed before HIV, Hepatitis C, Diabetes
December 31, 2022. and Depression
* Check with your plan administrator for reward offerings specifc to your plan. Only Dean Health Plan members, ages 18 and older, are eligible for Living
Healthy Rewards. Your employer may be required to report health plan-issued incentives as taxable income. Dean Health Plan may be required to report
incentive payment information to your employer. Your health information is protected by federal law and will not be shared with your employer. Adult
dependents (ages 18 and older) who are covered under a family member’s policy can earn up to $100 in Dean Health Plan’s Living Healthy Rewards program.
We are here to help
Visit deancare.com/rewards
deancare.com/medicareadvantagemembers | 15Getting Started
Need to know where to go for care?
Getting the Right Care Call the 24-Hour Nurse Advice Line*
at 800-576-8773 (TTY: 711).
at the Right Place Experienced registered nurses are
here to help 24/7/365.
at the Right Time *Due to licensing regulations, 24-Hour Nurse
Advice Line triage services are only available
to Wisconsin residents.
The Importance of Primary Care
We ask our members, at enrollment, to select attack symptoms (chest pain, shortness of
a primary care provider (PCP) within the Dean breath, nausea/vomiting), stroke symptoms
network when you enroll. This is because (slurred speech, sudden weakness and vision
our coverage options emphasize a proactive, loss, and dizziness), and head trauma or sudden
preventive approach to care – one where a confusion. Call 911 if you think your health
PCP oversees all aspects of your health care problem is life-threatening or could worsen
needs and keeps you well through regular visits. on the way to the hospital.
Your PCP should serve as your first point of
contact when medical care is needed, especially Specialty Care
for treatment of a chronic condition or for In addition to primary care, the Dean network
preventive care. includes a variety of medical specialties. Your
PCP can help you select the specialist who is
Urgent Care** right for you. Visit deancare.com/doctors for
If you need a same-day appointment, try calling our online provider directory, which contains a
your primary care clinic first, as appointments comprehensive list of Dean’s specialty providers,
are often available the same day for immediate behavioral health services and hospitals. Turn to
treatment. Your clinic may direct you to go to page 26 for more information about specialty
urgent care if you need attention sooner than a care and when a prior authorization might be
clinic visit. Common reasons to visit urgent care needed for these types of services.
include minor burns, sprains or strains, minor
lacerations or rashes, and migraines. Urgent care E-Visit
sites are generally open evenings and weekends. Go to deancare.com/evisit to get a diagnosis,
a treatment plan and even a prescription, if
Emergency Care** needed! E-Visits are available to members
Severe illnesses, injuries and symptoms might through age 80. To ensure members receive the
mean you need emergency care. Common highest quality of care, those age 81 and above
reasons to seek emergency care include heart should be seen at a clinic or doctor’s office.
**Both urgent and emergency care are covered under your plan if you are not able to return to the Dean Health Plan
network for immediate treatment. If you require urgent or emergency care outside the network and are unable to get
to a plan provider, please go to the nearest urgent care center or emergency room for treatment. It is important to
16 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanTips for a Schedule Your Annual Wellness
Better Appointment Visit and Annual Physical Today
Creating a strong, trusting relationship Your annual wellness visit and annual physical
with a primary care provider (PCP) is at the are at the core of your preventive care plan.
heart of our preventive care philosophy at Preventive screenings can catch diseases, such
Dean Health Plan. as cancer, early when they are most treatable.
By regularly scheduling your annual wellness
visit and annual physical, your PCP will be more
familiar with your health history and can make
better recommendations about your care.
Plan Ahead Ask Questions
Bring a list of your symptoms, including when Don’t hesitate to ask a question of your PCP
they started, how often they occur and what if you do not understand something.
eases them before coming to a diagnostic
appointment. List any other topics you also want Be Open and Honest
to discuss with your PCP. Talk about the most The more your PCP knows about your lifestyle,
important concerns first. the better he or she is able to treat you. Be
prepared to discuss details like where you live,
Talk About Preventive Care family medical history, your diet and sleeping
During a routine or annual checkup, make sure habits.
to talk to your PCP about what preventive
screenings may be right for you and when you Take Notes
should have them. See page 22 for preventive Write down information or ask your
care details. PCP to make notes for you during
your appointment. You might consider bringing
Bring Your Medications a friend or family member to take notes and help
Bring in bottles of your current prescriptions you remember important information.
and the over-the-counter medications and
supplements you take. (Put them in a bag so you Contact Your PCP
can easily carry everything.) Also, be sure If you have more questions or have problems
to write down the contact information for any with medications, call your PCP or send a
other providers, a list of your allergies and any message through MyChart (or another secure
pertinent medical information. online health messaging system).
notify Dean of your out-of-network urgent or emergency visit by calling the Customer Care Center at 877-232-7566
(TTY: 711). If you are enrolled in an HMO plan, a plan provider should deliver all follow-up care. Out-of-network care
services require approval by Dean Health Plan unless you are enrolled in a HMO-POS plan.
deancare.com/medicareadvantagemembers | 17Using Your Plan
Questions on prescription drug coverage?
Drug Coverage Reach out to our Customer Care
Center at 877-232-7566 (TTY: 711),
Questions and Answers 8 am – 8 pm, weekdays (year-round)
and weekends (Oct. 1 – Mar. 31).
Medicare drug coverage can be hard to
understand. Here are answers to some of
our most frequently asked questions:
Are my drugs covered What is the diference between
Q by the plan? Q Part D and Part B drugs?
Our plan uses a drug formulary It is important to understand the
to determine how each drug is diference in coverage as Part D
A covered and any requirements for
coverage. Visit deancare.com/ A drugs are covered under the drug
beneft while Part B drugs are
medicareadvantagemember to considered a medical beneft:
view our comprehensive drug
formulary. The formulary allows
• Part D drugs are the more common drugs you
you to search by drug name, type
get at the pharmacy counter and can be self-
or tier. See your plans Evidence of
administered. See chapters 5 and 6 of your
Coverage to calculate how much
Evidence of Coverage document to learn more
you can expect to pay for drugs in
about Part D drugs.
each tier.
• Part B drugs are drugs that are either given
in a doctor’s ofce, home infusion or an
outpatient clinic that you cannot self administer
or these drugs are oral drugs or supplies for
certain chronic disease states that you can pick
up at your local pharmacy. Some examples
of drugs given in a clinic include injectable
anticancer drugs, intravenous immune globulin
or injectable dialysis drugs. Drugs that you
could pick up at your pharmacy include those
drugs Oral transplant medication, nebulized
drugs, some oral chemotherapy and diabetic
supplies for testing. Please be aware these
drugs will have either a co share amount
or a copay.
18 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanCan using mail order Why does my cost sharing for a
Q really provide savings? Q drug change through the year?
The mail order program can provide The Medicare Part D program has
savings through the Initial Coverage four defned segments of beneft
A Stage, as we ofer discounted
copays on a 90-day supply for tiers A oferings known as the Deductible
Stage, Initial Coverage Stage,
1, 2 and 3. Using mail order is also Coverage Gap and Catastrophic
convenient! You can avoid taking Stage. Each beneft segment
time to drive to a pharmacy by may have diferent member cost
having your drugs delivered sharing amounts. The coverage
to your home. You can get a 90 and description of these beneft
day supply of many drugs at most segments can be found in
pharmacies at the same discounted Chapter 6 of your Evidence
price as mail order drugs. of Coverage document.
deancare.com/medicareadvantagemembers | 19Using Your Plan
Need to find a pharmacy near you?
Understanding Visit deancare.com/
medicareadvantagemembers
Your Prescription to find preferred pharmacies and
standard retail pharmacies near you.
Drug Coverage*
How to use your pharmacy benefit
Members save money by filling Insulin Savings
prescriptions in our preferred retail You only pay a $30 copay per prescription at
pharmacy network and through our preferred pharmacies and $35 at standard retail
mail order pharmacy. pharmacies for insulin included on our formulary
• All SSM Pharmacies, until you reach the catastrophic coverage stage.
These savings apply through the deductible and
Walgreens and
copay stages and the donut hole.
Walmart pharmacies
• Costco** retail and mail Drug Formulary
order pharmacies Your prescription coverage is based on a drug
Members have access to formulary, or list of drugs, used by Dean Health
standard retail pharmacy network Plan to help you differentiate what is and isn’t
that includes: covered. The Dean Health Plan formulary breaks
the drug list into tiers, indicating different levels
• Most national pharmacy chains,
of cost sharing. As with most prescription drug
including CVS
coverage, there are limitations to coverage
• Many retail and grocery that help keep plan costs down. Make sure
store pharmacies you are familiar with both your plan’s specific
• Many independent, local coverage details and our general limitations and
community pharmacies procedures as explained on the following page.
The formulary, pharmacy network,
and/or provider network may
change at any time. You will Save money by filling your
receive notice when necessary. prescriptions at Preferred
Pharmacy locations
* No prescription coverage for Harmony MA-only.
**You do not need to be a Costco member to use the Costco Pharmacy.
20 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanFor more information…
Understanding To view our drug formulary and other
pharmacy resources visit deancare.com/
Your Prescription medicareadvantagemembers
Drug Coverage*
Formulary Management Procedures
The Dean Health Plan drug formulary is reviewed prescription or per a specific amount of time.
every month and updated on a regular basis. For For example, we may limit a drug to 60 tablets
example, we update the drug formulary when a over a 30 day period.
new generic drug is approved. Visit deancare.
com/medicareadvantagemembers and click on • Step Therapy: In some cases, Dean Health Plan
2022 Drug list/formulary for the most up-to- requires you to first try certain drugs to treat
date drug formulary details. your medical condition before we will cover
another drug for that condition. For example,
Restrictions and limitations apply to the drug if Drug A and Drug B both treat your medical
formulary, when necessary: condition, Dean Health Plan may not cover
Drug B unless you try Drug A first. If Drug A
• Prior Authorization: Dean Health Plan requires does not work for you, then Drug B will be
you or your physician to get prior covered.
authorization for certain drugs. This means
that you will need to get approval from • 90 Day Supply of Drugs: You may be able to
Dean Health Plan before you fill your receive a 90 day supply of most drugs on our
prescriptions. If you don’t get approval, drug formulary. These drugs are available with
the drug will not be covered. The drug reduced cost sharing at most pharmacies and
formulary lists drugs that need prior through our convenient mail order service.
authorization. You may also call the Customer Drugs not available through mail order are
Care Center for questions or information about noted with “NM” in the notes column of the
your prescription drug benefits. drug formulary.
• Quantity Limits: For certain drugs, Dean • Limited Distribution: The Food and Drug
Health Plan limits the amount of the drug Administration restricts certain drugs to
that you can have each time you fill your certain pharmacies. These drugs can only be
prescription. The amount or supply of the drug obtained at specialty-designated pharmacies
product dispensed can be limited either per able to appropriately handle the drugs.
*No prescription coverage for Harmony MA-only.
deancare.com/medicareadvantagemembers | 21Medicare Advantage
Preventive Care
By focusing on preventive care and
wellness, we can work together to
help you stay well and avoid illness.
Welcome to Medicare Office Visit Annual Wellness Visit and Annual Physical
As soon as you enroll in Medicare Part B, you At this visit, the following preventive services, and
can schedule your welcome to Medicare visit. more, are covered at no ($0) out-of-pocket costs
This visit is covered at no cost to you. to you when received by an in-network provider:
• Breast cancer mammography screening
During this visit, your primary care physician
(PCP) will record your medical history and check • Colorectal cancer screening
your vision, blood pressure, and weight and • Prostate cancer screening
height to measure your body mass index (BMI).
• Diabetes screenings, monitoring supplies
This visit is also a great way to get up-to-date on and self-management training
important screenings and shots and to talk with • Annual Physical
your doctor about your family’s medical history
During this visit, your PCP will take a medical/
and ways to manage your health.
family history and may perform a head-to-
toe general health assessment with hands-on
examination of all the body systems. An annual
wellness exam does not necessarily involve a
physical exam—your provider may or may not
do both of these together.
Did You Know?
When you are new to Medicare Advantage you can schedule your Welcome
to Medicare AND an Annual Wellness Visit.
• Your Welcome to Medicare visit is covered at no cost ($0) to you during your
first year of enrollment.
• The Annual Wellness and PCP visits are covered at no cost ($0) to you.
22 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanVaccinations* Other Preventive Services
Vaccines will cost $0 copay to help you stay All preventive services are listed in your
healthy. It is important to keep vaccines current: Evidence of Coverage. See the Medical Benefits
you may not have been vaccinated as a child or chart in Chapter 4, Section 2.1. You will see an
your immunity may have faded. Most importantly, apple listed next to the preventive services in
vaccines help keep you safe from possible life- the benefits chart.
threatening, vaccine-preventable, diseases.
Telehealth
Part B Vaccines Telehealth can be used to assess your risk for
Medicare Part B covers these vaccines certain health conditions. It may also be used
when received in your clinic: for your annual preventive visit or for other
appointments if you do not need lab work
• Annual flu shot
or vaccines. Talk with your PCP and ask if a
• Hepatitis B for intermediate to high risk telehealth appointment is right for you.
• Pneumococcal pneumonia
• Tetanus shot, but only due to an injury
Part D Vaccines
Medicare Part D covers these vaccines when
received at an in-network pharmacy. You must
receive the Part D vaccine in the pharmacy for it
to be covered.
• Hepatitis B for low risk members
• Shingles
• Td (tetanus and diphtheria) booster
• Tdap (tetanus, diphtheria, and pertussis)
booster
* Your plan must include Part D for Part D vaccines to be covered.
deancare.com/medicareadvantagemembers | 23Using Your Plan
Struggling to manage your diabetes?
Medicare Advantage Get the help you need by completing
our Care Management form to
Diabetes Benefits be connected with a nurse case
manager. Visit deancare.com/
wellness/care-management
Dean Health Plan understands the special
needs of individuals with diabetes. Our
Medicare Advantage plans offer specific
benefits geared toward those needs.
Diabetes Management Insulin Savings
Do you have diabetes? Does insulin play a role in managing your
Make sure you are taking steps to stay healthy: diabetes? We can help. Our plans offer reduced
copays on insulin until you reach the catastrophic
• Get an HbA1c test at least twice stage of Medicare Part D coverage. We offer:
a year to check your average
blood glucose level for the past • $30 insulin fills at preferred
two to three months. pharmacy locations.
• Get an LDL test when you are • $35 insulin fills at standard
first diagnosed with diabetes retail pharmacies.
to check your level of “bad”
cholesterol, and repeat • Our insulin savings program
testing as recommended applies to all insulins on the
by your doctor. formulary,* including:
Fiasp 100 unit/ml
• Get diabetic kidney Humulin R 500 unit/ml
disease testing. Levemir 100 unit/ml
• Get an eye exam which may Novolin 70/30 unit/m
include a dilated retinal exam. Novolog 100 unit/ml
Lantus 100 unit/ml
• Get a regular foot exam.
Novolin N 100 unit/ml
• Eat a healthy diet and Novolin R 100 unit/ml
exercise regularly. Soliqua 100un/0.033mg/ml
Toujeo 300 unit/ml
• Stay active. Register
Toujeo 100 unit/ml
for Silver&Fit.
Tresiba 100 unit/ml
Tresiba 200 unit/ml
Xultrophy 100unit/3.6mg/ml
*Includes Pen Injector, Injectable Solution, Injectable Suspension and Cartridge.
24 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanDiabetic Supplies
$0 Diabetic Supplies
Insulin supplies
Supplies to monitor your blood glucose are
Insulin supplies are covered under the Part D
covered at $0. Covered supplies include blood
benefit. Covered insulin supplies include syringes,
glucose monitors, blood glucose test strips,
needles, alcohol swabs and gauze. Insulin
lancet devices and lancets, and glucose-control
supplies are on Tier 2 of our formulary. The Tier
solutions for checking the accuracy of test strips
2 copay is $5 at preferred retail pharmacies and
and monitors. Diabetic testing supplies must be
$12 at standard retail pharmacies.
Accu-Chek brand in order to be covered.
Therapeutic Shoes and Inserts
Continuous Glucose Monitors
For people with diabetes who have severe
Continuous glucose monitors are covered at $0.
diabetic foot disease, we cover one pair per
Continuous glucose monitors and supplies must
calendar year of therapeutic custom-molded
be obtained at a pharmacy and be FreeStyle
shoes (including inserts provided with such
Libre or Dexcom brand. Ask your doctor if you
shoes) and two additional pairs of inserts, or one
meet Medicare guidelines for the $0 continuous
pair of depth shoes and three pairs of inserts
glucose monitor benefit.
(not including the non-customized removable
inserts provided with such shoes). This coverage
Insulin Pumps
includes fitting. You will pay 20% coinsurance
Insulin pumps covered by our plan
in-network for therapeutic shoes and inserts.
are Minimed, T Slim and Omnipod. Insulin
Therapeutic shoes and inserts are only available
pumps are covered under the Durable Medical
through NPS Foot Health.
Equipment (DME) benefit. You will pay 20%
coinsurance in-network for insulin pumps.
Minimed and Omnipod testing supplies you Benefits Supporting Diabetes Management
will pay 20% coinsurance. $0 Part C Benefits
• PCP Visits
• Labs
• Diabetic Supplies
• Kidney Disease Education
deancare.com/medicareadvantagemembers | 25Using Your Plan
Understanding
Prior Authorization
Making sure it’s covered
As you navigate your health care, it’s important Services that may require a prior
to remember that certain medical services authorization include, but are not
require prior authorization. If it is determined limited to:
that your specific service need requires this, it
must be submitted to Dean Health Plan. • Medically-related
dental services
Dean Health Plan will not cover the
cost of certain medical services if your • Radiology services
prior authorization request is not received • Durable medical equipment
or approved.
• Mental health care
• Outpatient therapy
• Outpatient substance abuse
• Outpatient surgery
• Prosthetic devices
• Inpatient hospital care
• Skilled nursing facility
• Certain drugs
(see formulary for more details)
• Out-of-network services*
*Members on HMO-POS plans do not require a prior authorization before using out-of-network services.
For HMO plans, if prior authorization is approved for out-of-network services, the member will pay the
in-network cost-sharing amount.
26 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanPlan Details
Need more information?
Your Rights and Reach out to our Customer Care
Center at 877-232-7566 (TTY: 711),
Responsibilities 8 am – 8 pm, weekdays (year-round)
and weekends (Oct. 1 – Mar. 31).
You deserve the best service and health
care possible. Rights and responsibilities
help foster cooperation among members,
practitioners and Dean Health Plan.
Visit deancare.com to view your Notice Limitations and Exclusions
of Privacy Practices or call the Customer Reference your Evidence of Coverage,
Care Center. which can be found online at deancare.com,
for a list of services and items that either
Grievance and Appeals are not covered under any condition or
We know that at times you may have questions are covered only under specific conditions.
or concerns about benefits, claims or services
you have received from Dean Health Plan.
When such a concern or complaint arises, we
encourage you to reach out to the Customer
Care Center. A Medicare Specialist will make
every effort to resolve your concern promptly
and completely. Your input matters, and we
encourage you to call with any concerns you
may have regarding your health care. As a
Dean Advantage member, you also have certain
grievance and appeals rights.
You can call the Customer Care Center or visit
deancare.com/medicareadvantagemembers
for more information on how to file a grievance
or appeal.
deancare.com/medicareadvantagemembers | 27Non-Discrimination Notice
The Health Plan*:
• Provides free aids and services to people with disabilities to
communicate effectively with us, such as: qualified sign
language interpreters and written information in other formats
(large print, audio, accessible electronic formats, other formats).
• Provides free language services to people whose primary
language is not English such as: qualified interpreters and
information written in other languages. If you need these
services, contact the Customer Care Center at 1-877-317-2410
(TTY: 711).
The Health Plan complies with applicable Federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, sex, or religion. The Health Plan does not exclude
people or treat them differently because of race, color, national origin, age, disability, sex, or religion.
If you believe that the Health Plan has failed to provide these services or discriminated in another way
on the basis of race, color, national origin, age, disability, sex, or religion, you can file a grievance with
the organization’s Civil Rights Coordinator. If you need help filing a grievance, the Civil Rights
Coordinator for the Health Plan is available to help you. You can file a grievance in person, by mail, or
email at:
Civil Rights Coordinator Phone: 1-608-828-2216 (TTY: 711)
1277 Deming Way Email: civilrightscoordinator@deancare.com
Madison, Wisconsin 53717
You can also file a civil rights complaint with the U.S. Department of Health and Human Services,
Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, by mail, or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building Phone: 1-800-368-1019 or 1-800-537-7697 (TDD)
Washington, D.C. 20201
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
*Dean Health Plan; Prevea360 Health Plan; WellFirst Health
2021-2022 General Tagline v1.0P
28 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health PlanLanguage Assistance
Spanish - ATENCIÓN: si habla Somali - DIGTOONI: Haddii aad
español, tiene a su disposición ku hadasho afka Soomaaliha,
servicios gratuitos de asistencia adeegyada caawimada luqadda
lingüística. Llame al waxaa laguu heli karaa iyagoo
1-877-317-2410 (TTY: 711). bilaash ah. Wac
1-877-317-2410 (TTY: 711).
Hmong - LUS CEEV: Yog tias
koj hais lus Hmoob, cov kev pab
txog lus, muaj kev pab dawb rau
koj. Hu rau 1-877-317-2410
(TTY: 711).
Polish - UWAGA: Jeżeli mówisz po polsku,
możesz skorzystać z bezpłatnej pomocy językowej.
Zadzwoń pod numer 1-877-317-2410 (TTY: 711).
Vietnamese - CHÚ Ý: Nếu bạn nói Tiếng Việt, có Arabic -
các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. ﻓﺈن ﺧﺪﻣﺎت، إذا ﻛﻨﺖ ﺗﺘﺤﺪث اذﻛﺮ اﻟﻠﻐﺔ:ﻣﻠﺤﻮظﺔ
Gọi số 1-877-317-2410 (TTY: 711). اﺗﺼﻞ ﺑﺮﻗﻢ.اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ ﺗﺘﻮاﻓﺮ ﻟﻚ ﺑﺎﻟﻤﺠﺎن
.(711 : )رﻗﻢ ھﺎﺗﻒ اﻟﺼﻢ واﻟﺒﻜﻢ1-877-317-2410
Tagalog - PAUNAWA: Kung nagsasalita ka ng Russian - ВНИМАНИЕ: Если вы говорите на
Tagalog, maaari kang gumamit ng mga serbisyo ng русском языке, то вам доступны бесплатные
tulong sa wika nang walang bayad. Tumawag sa услуги перевода. Звоните 1-877-317-2410
1-877-317-2410 (TTY: 711). (телетайп: 711).
German - ACHTUNG: Wenn Sie Deutsch
sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufnummer:
1-877-317-2410 (TTY: 711).
French - ATTENTION : Si vous parlez français, Urdu -
des services d'aide linguistique vous sont proposés ﺗﻮ آپ ﮐﻮ زﺑﺎن ﮐﯽ ﻣﺪد، اﮔﺮ آپ اردو ﺑﻮﻟﺘﮯ ﮨﯿﮟ:ﺧﺒﺮدار
gratuitement. Appelez le 1-877-317-2410 ﮐﯽ ﺧﺪﻣﺎت ﻣﻔﺖ ﻣﯿﮟ دﺳﺘﯿﺎب ﮨﯿﮟ ۔ ﮐﺎل ﮐﺮﯾﮟ
(ATS : 711). 1-877-317-2410 (TTY: 711).
Italian - ATTENZIONE: In caso la lingua parlata
sia l'italiano, sono disponibili servizi di assistenza
linguistica gratuiti. Chiamare il numero
1-877-317-2410 (TTY: 711).
H9096_tagline0821_C H5264_tagline0821_C
1-877-234-0126 (TTY:711) | deancare.com/medicare | 29Your Notes 30 | 2022 New Member Guide | Dean Advantage Medicare Coverage by Dean Health Plan
Follow us on LinkedIn and Facebook Dean Health Plan, Inc. 1277 Deming Way Madison, WI 53717 Local: 608-828-1941 Toll-free 877-234-0126 (TTY: 711) deancare.com/medicare Dean Health Plan, Inc. is a HMO/ HMO-POS with a Medicare contract. Enrollment in Dean Health Plan, Inc. depends on contract renewal. Dean Health Plan markets under the names Dean Advantage and Prevea360 Medicare Advantage. This information is not a complete description of benefits. Call 877-234-0126 (TTY: 711) for more information. You must continue to pay your Medicare Part B premium. ©2021 Dean Health Plan, Inc. H9096_545291R03_C
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