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Website last updated: 9/30/2013 Y0041_HNS_14_9867 Approved 12/17/13

AmeriHealth HMO, Inc. is an HMO plan with a Medicare contract. Enrollment in AmeriHealth HMO, Inc. depends on contract renewal.

AmeriHealth Rx is a PDP plan with a Medicare contract. Enrollment in AmeriHealth Rx depends on contract renewal.

Please contact AmeriHealth Customer Service for more information.

You must continue to pay your Medicare Part B premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.

Medicare beneficiaries may enroll in AmeriHealth 65® NJ HMO, AmeriHealth 65® Preferred HMO or AmeriHealth® Rx PDP through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

For accommodation of persons with special needs at sales meetings call toll-free 1-888-678-7007 (1-888-457-3002 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. A sales person will be present with information and applications. However, please be aware that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.

We also list pharmacies that are in our network but are outside of the New Jersey, Pennsylvania, and West Virginia area. Please contact the plan toll-free 1-888-678-7007 (1-888-457-3002 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week, for additional information.

To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact AmeriHealth 65 Preferred HMO Customer Service at 1-800-645-3965; AmeriHealth Rx PDP Customer Service at 1-888-678-7007. TTY/TDD users should call 1-888-857-4816 (AmeriHealth 65 Preferred HMO); 1-888-457-3002 (AmeriHealth Rx PDP), 7 days a week, 8 a.m. to 8 p.m.

For additional information from the Centers for Medicare and Medicaid Services (CMS) visit www.medicare.gov. If you prefer to file a grievance through CMS, please complete the Medicare Complaint Form. For additional assistance, visit The Office of the Medicare Ombudsman.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

This information is available for free in other languages. Please call our customer service number at 1-866-569-5190, seven days a week, 8 a.m. to 8 p.m. However, please be aware that on weekends and holidays from February 15 through September 30 your call may be sent to voicemail.

Esta información está disponible gratis en otros idiomas. Por favor llame a nuestro número de servicio al cliente al 1-866-569-5190, los siete días de la semana, 08 a.m.-8 p.m. Sin embargo, tenga en cuenta que los fines de semana y festivos del 15 de febrero al 30 de septiembre la llamada puede ser enviada al correo de voz.

© 2014 AmeriHealth