Medicare Advantage Employer Group Benefits (2020)
These plans are available for businesses to offer their Medicare-eligible employees and retirees residing in the service areas listed below. The Summary of Benefits, Evidence of Coverage, and other information below explain the details about each plan.
Service area: You must live in Flagler County, Hardee County, Highlands County, Seminole County or Volusia County in Florida to enroll in these plans.
- Benefits
- Summary of Benefits
- Evidence of Coverage
- Prescription drug information
- Formulary and pharmacies
- Forms
- Requirements
- Extra help for prescription drug costs
- Provider and pharmacy directories
- Your privacy, rights, and procedures for grievances, appeals, and exceptions
- How to enroll
Benefits
Summary of Benefits — These booklets explain general information about the plans we have for employer groups. They also include information about premiums, cost sharing, out-of-network coverage, any limitations, and more.
Group POS B/Plus C/Plus D Summary of Benefits
Annual Notice of Change —These documents explain the changes that happened from last year to this year:
- Group POS B Annual Notice of Change
- Group Plus C Annual Notice of Change
- Group Plus D Annual Notice of Change
Evidence of Coverage —These documents contain the most detailed information about the Group plans:
- Group POS B Evidence of Coverage
- Group Plus C Evidence of Coverage
- Group Plus D Evidence of Coverage
Prescription drug information
Formulary and pharmacies
- Comprehensive formulary — a complete list of covered drugs
- Searchable Formulary
- Formulary Annual Notice of Change
- Formulary Monthly Notice of Change
Forms
- Mail order prescriptions from MedVantx
- Mail order prescriptions from Health First Family Pharmacy
- Prescription reimbursement form
Requirements
- Prior Authorization and Step Therapy Criteria
- Transition policy
- Medication therapy management
- Drug and/or Utilization Management
Extra help for prescription drug costs
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1.800.MEDICARE (1.800.633.4227). TTY/TDD users should call 1.877.486.2048, 24 hours a day/7days a week;
- The Social Security Administration at 1.800.772.1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1.800.325.0778; or
- Your State Medicaid Office.
Assistance with Best Available Evidence for Low Income Subsidy
Provider/pharmacy directories
Your privacy, rights, and procedures for grievances, appeals, exceptions
Part D prescription drug prior authorizations, exceptions, appeals and grievances
Medical prior authorizations, appeals, and grievances
Please refer to your Evidence of Coverage (EOC) for more details about these topics, as well as your rights and responsibilities upon disenrollment:
For more information about our quality assurance policies and procedures or to obtain an aggregate number of the our grievances, appeals, and exceptions, contact customer service.
How to enroll
If your employer (or former employer) offers Health First Health Plans as part of their employee or retiree benefits, check with them for details on how and when to enroll. They may prefer you send your completed enrollment form (and premium payment if necessary) to them. If they ask you to contact us directly to enroll, please follow these instructions.
AdventHealth Advantage Plans is administered by Health First Health Plans. Health First Health Plans is an HMO plan with a Medicare Contract. Enrollment in Health First Health Plans depends on contract renewal. This information is not a complete description of benefits. Call
Y0089_EL7848AH_M | Accepted date: 10/1/2019
Last updated: 10/1/2019