Disclaimers

United American Insurance Company is a Medicare-approved Part D sponsor. Plan sponsors can choose not to renew their contract with CMS, and CMS may also refuse to renew the contract, thus resulting in a termination or nonrenewal. This may result in termination of the beneficiary's enrollment in the plan. In addition, the plan sponsor may reduce its service area and no longer offer services in the area where the beneficiary resides.

Eligibility Requirements
To be eligible for and to enroll in United American Part D Prescription Drug Plans (PDP), you must be:

• Eligible to receive Medicare benefits under Part A or enrolled in Part B.
  
• A resident in the United American Part D Prescription Drug Plans? (PDP) service area (all states except New York).

Medicare beneficiaries may enroll in United American Part D through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Important Information

You may only be enrolled in one Part D plan at a time. If you are enrolled in a Medicare Advantage (MA) plan, you may not enroll in United American Part D unless you are a member of a Private Fee-for-Service (PFFS) or a Medical Savings Account MA (MSA) plan.

Pharmacy Information
United American Part D Prescription Drug Plans (PDP) have formed a network of pharmacies. You must use a network pharmacy to ensure you receive plan benefits. Our Part D Plans may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time.

Pharmacy Access
This plan has contracts with pharmacies that equal, or exceed, CMS requirements for pharmacy access in your area. In most cases, your prescriptions are covered under this plan only if they are filled at a retail network pharmacy or through our mail-order pharmacy. We will fill prescriptions at out-of-network pharmacies under certain circumstances. Quantity limitations and restrictions may apply. Long-term care and home infusion pharmacies may service a broad area. Therefore, you may need to look outside your immediate area for these types of providers.

Medicare Part D Extra Help
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, you can call any of the numbers below:

United American Part D Customer Service | Contact Us
1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/seven days a week.
The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778. Visit the website at www.ssa.gov
Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for 75% of drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day/seven days a week. TTY users should call 1-877-486-2048.

If you qualify for Extra Help for your Medicare prescription drug plan costs, the amount of your premium and cost at the pharmacy are less. Once you are enrolled in a United American Prescription Drug Plan (PDP), Medicare tells us how much assistance you receive. We then send you information on the amount of premium you will pay.

Medicare Supplement (Medigap) Policies with Part D
If you have a Medicare Supplement (Medigap) policy that includes prescription drug coverage, you must contact your Medigap provider to tell them you joined a Medicare prescription drug plan. If you keep your Medigap policy, your Medigap provider removes the prescription drug coverage portion of your policy and adjusts your premium. Under certain circumstances, you can buy a different Medigap policy without prescription drug coverage sold by your Medigap provider. Your Medigap provider cannot charge you more based on any past or present health conditions. Call your Medigap provider for details.

Plan Ratings Information
Plan performance Star Ratings are assessed each year and may change from one year to the next.

Updated 10/01/12