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Provider Manual

Eligibility and Enrollment

Last Updated on August 28, 2018

Eligibility

Members may enroll in a Security Health Plan Medicare Advantage plan if they are entitled to Medicare Part A and enrolled under Medicare Part B and live in the Medicare Advantage service area. A member is eligible to join Medicare Advantage irrespective of any medical condition except end stage renal disease (ESRD). For eligibility purposes, individuals who have received a transplant which restores kidney function, and/or who no longer require a regular course of dialysis to maintain life, are not considered to have ESRD.

Enrollment

If a member is entitled to Medicare Part A and enrolled in Medicare Part B, and residing in the service area, he/she may enroll in Medicare Advantage. If a member has coverage through another Medicare health plan or prescription drug plan, membership in that plan will automatically end on the effective date of the member’s enrollment in Medicare Advantage.

Effective Date

Security Health Plan will notify the member in writing of his/her effective date of coverage along with a Medicare Advantage membership card.
Medicare Advantage member(s) will also be notified of Centers for Medicare & Medicaid Services’ (CMS) approval/rejection. If an application for membership is rejected by CMS, the member will be notified in writing, including the reason for the rejection. Medicare Advantage members must use their membership card, not their red, white, and blue Medicare card, when accessing services. If Medicare Advantage members receive services using their red, white, and blue Medicare card, the Medicare program will not pay for these services and Medicare Advantage members may have to pay the full cost.