Important plan documents

Benefits highlights PDF | Opciones de planesSpanish (en español PDF)

Getting medical care & prescription drugs in disaster or emergency areas

If the Governor of California, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in Monterey County, you can still get medical care and prescription medications from Aspire Health Plan.

Generally, during a disaster or emergency, Aspire Health Plan will allow you to obtain medical care from out-of-network providers at in-network cost-sharing rates without prior authorization requirements. In cases where payment is required up front for the out-of-network care you may submit a request for reimbursement to the plan.

Aspire Health Plan has a national network of pharmacies available to fill prescriptions for medications. If you cannot use a network pharmacy during a disaster, you may be able to fill your prescription drugs at an out-of-network pharmacy. In cases where payment for the cost of the drugs is required at the time the prescription is filled you may submit a request for reimbursement to the plan.

For more information on how to obtain needed care and medications during a disaster or emergency please call the Aspire Health Plan customer service team toll free at 855-570-1600(TTY users call 711), 8 am to 8 pm PST Monday through Friday (except certain holidays) from April 1 through September 30 and 8 am to 8 pm PST seven days a week for the period of October 1 through March 31.

We are committed to ensuring your health information is safe, while giving you the flexibility to have a family member, friend or loved one – your “representative” – help make decisions on your behalf. State and federal law requires different forms to be used depending on the actions you want your representative to take on your behalf. We’ve outlined the purpose of each of these forms below.

Authorization for Use or Disclosure of Health Information.
Completing the Authorization for Use or Disclosure of Health Information form will allow your designated representative to call Member Services to ask medical questions. This form is valid for as long as you are an Aspire Health Plan member. USE FOR: Medical benefit questions, claims, and bills.

• This form doesn’t override a Power of Attorney (POA). Don’t complete this form if you have a valid POA.
• You need to complete a separate form, if you need help filing an initial request for coverage, a grievance or appeal.
• This form is valid as long as you are a health plan member
• You have the right to revoke this document at any time

Appointment of Representative form.
Completing the Appointment of Representative allows your designated representative to call our Pharmacy Benefits Manager, MedImpact, to ask questions about your Part D prescription drug benefits, claims, or bills. It also allows the authorized representative to fi le an appeal or grievance for you or make an initial coverage request. You will renew this form each year. USE FOR: Part D prescription drug benefits, claims, bills, appeals, or grievances.

• This form only allows your representative to assist you with initial coverage requests, grievances or appeals.
• Your doctor can make a coverage request and file certain appeals without being your representative.
• This form is only valid for one year.
• The form should be signed by both you and the individual you would like to represent you.
• Once you have completed the form, you must submit that form via fax for mail to the applicable fax number or address listed above before we can talk to your representative.
• You have the right to revoke this document at any time

Already have a Power of Attorney (POA)? Make sure it’s Valid
A valid POA must:

• Name your agent and your relationship to the agent
• State when it becomes effective (e.g., “immediate”) and how long it lasts
• Include the right to revoke at any time
• Be properly signed AND notarized or witnessed

Aspire Health Plan provides comprehensive medical and pharmacy benefits, including preventive care and screenings for all our Medicare Advantage plans. If you’re looking to enhance your coverage we offer optional supplemental benefits. We have two packages to meet your needs. For an additional monthly premium, you can add dental vision, hearing, transportation and post discharge meals to any one of our three plans.

Option A – $44.90 additional premium per month includes:

• Dental
• Vision

Option B – $49.90 additional premium per month includes:

• Dental
• Vision
• Hearing
• Transportation – 10 additional rides
• 14 home delivered meals, post discharge

For a complete listing of all the benefits:

If you rely on regular or long-term medications, there may be a better way to get your prescriptions filled.  MedImpact Direct is home delivery and a smart, simple way for you to get prescriptions delivered to your door. Mail order pharmacy. And, you save money on your prescription co-pays with our 3 months supply for two co-payments.

If you would like to request a mailed copy of the current Provider and Pharmacy Directory, or if you need help finding a network provider and/or pharmacy, please call member services toll free at (855) 570-1600 (TTY users call 711) or click on the following link for more information:

Provider and Pharmacy Directory notice PDF |  Aviso de Directorio de Proveedores y FarmaciasSpanish (en español PDF)