General Questions:
- Who is eligible for Senior Preferred?
- What premium payment options do I have?
- Whom do I contact when I have a question regarding my claim?
- Is my routine doctor's visit paid every 12 months or calendar year?
- How do I find a doctor?
- How can I change my Personal Physician?
- Am I covered when I am out of the service area?
- How do I get a new ID card?
- What rights and responsibilties do the Plan and I have upon disenrollment?
- What is the difference between a Designated Representative or Durable Power of Attorney?
Part D Questions:
- What if I already have prescription drug coverage through Senior Care, Veterans Administration or a Retiree Plan?
- Will over-the-counter drugs be covered?
- What is my prescription coverage if I am out of the service area?
Privacy Questions:
- What is HIPAA?
- What do I do if I believe that my privacy rights have been violated?
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General Questions
Who is eligible for Senior Preferred?
In order to be eligible for Senior Preferred, you need to be a resident of Crawford, Jackson, La Crosse, Monroe, Trempealeau or Vernon counties or located in one of our approved
partial county service areas. Also, in order to be eligible for any Medicare Advantage program, including Senior Preferred, you must be entitled to Medicare Part A and enrolled in Medicare Part B.
What premium payment options do I have?
You can elect from three different premium payment options including coupon book, automatic withdrawal from your bank account or automatic withholding from your Social Security check. Please note, cash payments are not acceptable.
Whom do I contact when I have a question regarding my claim?
Contact our Senior Preferred Representatives at (800) 394-5566 or (608) 775-8077 for assistance. Our staff is ready to help you. You can also meet with one of our representatives in person by visiting the Health Resource Center located in the main lobby of Gundersen Clinic at 1836 South Avenue in LaCrosse, Wisconsin or visit our office located at 3190 Gundersen Drive in Onalaska, Wisconsin.
Is my routine doctor's visit paid every 12 months or calendar year?
Senior Preferred members are eligible for one routine physical, hearing and vision exam each calendar year.
How do I find a doctor?
Refer to the
Senior Preferred Provider Directory or contact our representatives at (800) 394-5566 or (608) 775-8077 for assistance.
How can I change my personal physician?
Contact our representatives at (800) 394-5566 or (608) 775-8077 for assistance.
Am I covered when I am out of the service area?
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside the service area.
How do I get a new ID card?
Contact our representatives at (800) 394-5566 or (608) 775-8077 for assistance.
What rights and responsibilties do the Plan and I have upon disenrollment?
Please refer to your
Evidence of Coverage.
What is the difference between a Designated Representative or Durable Power of Attorney?
A Durable Power of Attorney (DPOA) allows one individual to make decisions on behalf of another. A DPOA remains in effective for life unless it is revoked. There are two types of DPOA, one that applies to financial decisions and one that applies to health care decisions. A Designated Representative Authorization allows you to designate another individual to discuss your personal information. It does not allow them to make decisions on your behalf. A Designated Representative Authorization remains in effect for two years unless revoked. You may also provide verbal consent to allow us to talk with another person you designate as your representative. However, your verbal consent is only valid on the day that it is given. If you would like to have another person continue to assist you, please submit a Designated Representative Authorization to us.
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Part D Questions
What if I already have prescription drug coverage through Senior Care, Veterans Administration or a Retiree Plan?
Anyone with current drug coverage through Senior Care, Veterans Administration (VA), Tricare, or a Retiree Plan can waive the Senior Preferred drug coverage if the coverage is at least as good as Medicare or better and continue to be covered by their Senior Preferred medical policy.
Contact us for further details.
Will over-the-counter drugs be covered?
Over-the-counter drugs are drugs that can be purchased without a prescription. Even with a prescription from your doctor, these drugs are not eligible for coverage with Senior Preferred and the cost of the drugs is not applied to your yearly out-of-pocket maximums.
What is my prescription coverage if I am out of the service area?
Our Senior Preferred Part D drug coverage is processed thru our pharmacy benefit manager, NPS. NPS has contracts with over 55,000 pharmacies nationwide, which exceeds the Medicare access guidelines. Therefore, you will have coverage for prescription drugs outside of our service area as long as you choose a pharmacy contracted thru NPS. You can
contact us to locate a pharmacy or use our on-line pharmacy directory.
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Privacy Questions
What is HIPAA?
The Health Insurance Portability and Accountability Act ("HIPAA") of 1996 is a federal law that applies to both insurance companies and providers. HIPAA provides portability and continuity of health insurance coverage as well as protection of your personal health information.
What do I do if I believe that my privacy rights have been violated?
If you have questions or concerns about the way the Health Plan has protected the privacy of your personal information, please contact the Privacy Specialist at 608-775-8754.
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