Federal Disasters

Getting Medical Care and Prescription Drugs in a Disaster or Emergency Area

If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from us. PrimeTime Health Plan will temporarily change our rules for affected member’s medical care and prescription drugs during an emergency or disaster as described below:

Medical Care

  • Allow members to see certain doctors or go to certain hospitals that accept Medicare patients, even if the doctor or hospital isn’t in our network and your health care isn’t an emergency.
  • Waive referral rules for out-of-network services.
  • Reduce plan-approved out-of-network cost-sharing to in-network cost-sharing amounts.

Pharmacy Access (Plans with Part D coverage)

  • Lift the “refill-too-soon” edits on your prescriptions if you had to leave your home without them or they were lost or damaged due to the emergency or disaster.
  • Allow you to obtain the maximum extended-day supply of your medication, if requested and available at the time of refill, at one of our extended-day supply pharmacies.
  • Allow access to covered Part D drugs dispensed at out-of-network pharmacies when you cannot obtain your covered drugs at a network pharmacy. You may have to pay more at an out-of-network pharmacy. If you pay full cost for your medications at an out-of-network pharmacy, you may submit your receipt for reimbursement consideration.

Replacing lost or damaged durable medical equipment or supplies (wheelchair, walker, diabetic supplies, etc.)

  • Equipment and supplies normally covered under the plan will be replaced at the network level of benefits if they are lost or damaged due to the disaster.

Replacing a lost plan member identification card

  • Contact our Service Center at the phone numbers listed below to replace a lost or damaged member identification card.

Paying your plan premium

  • If your plan has a monthly plan premium and you pay us directly, you can sign up for premium withholding from your Social Security check or pay by electronic funds transfer through your bank. Contact our Service Center at the phone numbers listed below for additional information.

Contact information

To get more information about getting care from doctors or other providers and prescription drugs during an emergency or disaster, please contact us:

Call: 330-363-7407 or 1-800-577-5084
TTY users: 330-363-7460 or 1-800-617-7446
Call Center Hours: Monday through Friday 8:00 a.m. to 8:00 p.m. (October 1 – February 14th, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)
Website: www.primetimehealthplan.com.

Last updated: 9/23/2015