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Important plan documents
The following documents provide important information on services and benefits to help you make an informed decision about enrolling.
2019 Plan
2020 Plan
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All-in-One Medicare Advantage Decision Guide
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Annual Notice of Change
Annual Notice of Change Aspire Health Advantage (HMO) PDF | Aviso Anual de Cambios para - Aspire Health Advantage (HMO) Spanish (en español PDF)
Annual Notice of Change Aspire Health Plus (HMO-POS) PDF | Aviso Anual de Cambios para - Aspire Health Plus (HMO-POS) Spanish (en español PDF)
Annual Notice of Change Aspire Health Value (HMO) PDF | Aviso Anual de Cambios para - Aspire Health Value (HMO) Spanish (en español PDF)
Annual Notice of Change Aspire Health Group Plus (HMO-POS) PDF | Aviso Anual de Cambios para - Aspire Health Group Plus (HMO-POS) Spanish (en español PDF) -
Appointment of Representative form
You have the right to appoint a person to file a coverage decision, appeal or grievance for you. You will need to fill out an Appointment of Representative form PDF. 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.
Appointment of Representative information PDF | Nombramiento de un Representante Spanish (en español PDF) Appointment of Representative information form Instructions PDF | Nombramiento del formulario de información del representante Instrucciones Spanish (en español PDF) -
Aspire Health privacy notice
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Benefit highlights
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Care in an emergency or disaster
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.
Claim Reimbursement request form PDF | Solicitud de reclamo para reembolso Spanish (en español PDF)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.
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Claim reimbursement request form
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Enhanced benefits - dental, vision and hearing
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:
Enhanced Benefits PDF | Beneficios mejorados Spanish (en español PDF) Enhanced Benefits enrollment form PDF | Formulario de inscripción de beneficios mejorados Spanish (en español PDF) Enhanced Benefits disenrollment form PDF | Formulario de Cancelación de Beneficios Mejorados Spanish (en español PDF) -
Enrollment instructions and forms
Aspire Health Plan enrollment form PDF | Formulario de inscripción de Aspire Health Spanish (en español PDF) Scope of Sales Appointment confirmation form PDF | Alcance del formulario de confirmación de cita de ventas Spanish (en español PDF) CMS Star Ratings PDF | Calificaciones por estrellas Medicare Spanish (en español PDF) Disenrollment form PDF | Forma de Desafiliación Spanish (en español PDF) -
Evidence of Coverage
Evidence of Coverage - Aspire Health Advantage (HMO) PDF | Evidencia de Cobertura - Aspire Health Advantage (HMO) Spanish (en español PDF)
Evidence of Coverage - Aspire Health Group Plus (HMO-POS) PDF
Evidence of Coverage - Aspire Health Plus (HMO-POS) PDF | Evidencia de Cobertura - Aspire Health Plus (HMO-POS) Spanish (en español PDF)
Evidence of Coverage - Aspire Health Value (HMO) PDF | Evidencia de Cobertura - Aspire Health Value (HMO) Spanish (en español PDF)
Where to find important documents PDF | Donde encontrar documentos importantes Spanish (en español PDF) -
FAQ
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Mail-order prescriptions
If you rely on regular or long-term medications, there may be a better way to get your prescriptions filled. The CastiaRx Home Delivery is the smart, simple way for you to get prescriptions delivered to your door. 2019 Mail Order Pharmacy. And, you save money on your prescription copays with our 3 months supply for two copayments.
Home Delivery registration form PDF | Formulario de inscripción para entregas a domicilio Spanish (en español PDF) -
Medicare Star Rating
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Member forms
Claim Reimbursement request form PDF | Solicitud de reclamo para reembolso Spanish (en español PDF)Late Enrollment Penalty (LEP) Appeals
Medicare's Redetermination request form PDF | Formulario de solicitud de redeterminación de Medicare Spanish (en español PDF) Electronic Funds Transfer form PDF | Formulario de transferencia electrónica de fondos Spanish (en español PDF) Member plan change form PDF | Formulario de cambio de plan de miembro Spanish (en español PDF) -
Multi-language interpreter services
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Provider Directory
Provider and Pharmacy Directory PDF | Directorio de Proveedores y Farmacias Spanish (en español PDF)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 Farmacias Spanish (en español PDF)
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Summary of Benefits for Monterey County
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All-in-One Medicare Advantage Decision Guide
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Annual Notice of Change
Annual Notice of Change Aspire Health Advantage (HMO) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Plus (HMO-POS) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Value (HMO) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Group Plus (HMO-POS) PDF -
Appointment of Representative form
You have the right to appoint a person to file a coverage decision, appeal or grievance for you. You will need to fill out an Appointment of Representative form PDF. 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.
Appointment of Representative information PDF | Nombramiento de un Representante Spanish (en español PDF) -
Aspire Health privacy notice
-
Benefit highlights
-
Care in an emergency or disaster
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.
Claim Reimbursement request form PDF | Solicitud de reclamo para reembolso Spanish (en español PDF)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.
-
Claim reimbursement request form
-
Enhanced benefits - dental, vision and hearing
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:
-
Enrollment instructions and forms
-
Evidence of Coverage
Evidence of Coverage – Aspire Health Advantage (HMO) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Plus (HMO-POS) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Value (HMO) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Group Plus (HMO-POS) PDF -
FAQ
-
Mail-order prescriptions
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. 2020 Mail order pharmacy. And, you save money on your prescription co-pays with our 3 months supply for two co-payments.
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Medicare Star Rating
-
Member forms
-
Multi-language interpreter services
-
Provider Directory
Provider and Pharmacy Directory PDF | Directorio de Proveedores y Farmacias Spanish (en español PDF)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 Farmacias Spanish (en español PDF)
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Summary of Benefits for Monterey County
For more information, you can visit the Medicare website or call
1-800-MEDICARE 24 hours a day/7 days a week (1-800-633-4227).
TTY users should call 1-877-486-2048