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AmeriHealth HMO, Inc. is an HMO plan with a Medicare contract. Enrollment in AmeriHealth HMO, Inc. depends on contract renewal. Benefits underwritten or administered by AmeriHealth HMO, Inc.

Please contact the Member Help Team 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, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

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.

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

A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-800-898-3492 (TTY: 711).

You may receive prescription drugs shipped to your home through our network mail order delivery program. Usually a mail-order pharmacy order will get to you in no more than 14 days. If you should not receive your prescription drugs, please call FutureScripts Secure at 1-888-678-7015, 7 days a week, 24 hours a day. Or, you can visit our website at www.amerihealthmedicare.com.

To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact AmeriHealth 65 Preferred HMO Member Help Team at 1-866-569-5190 or AmeriHealth Medigap Plans Member Help Team at 1-866-406-5967; 7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.

This information is available for free in other languages. Please call our Member Help Team number at 1-800-898-3492, 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 1-800-898-3492, los siete días de la semana, 8 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.

AmeriHealth Medigap Plans are offered through AmeriHealth Insurance Company of New Jersey. AmeriHealth Medigap Plans are not connected with or endorsed by the U.S. government or the federal Medicare program. You must continue to pay your Medicare Part A (if applicable) and Part B premiums. If applying during a non-open enrollment or non-guaranteed issue period, your eligibility may be subject to medical underwriting and/or a rate increase due to tobacco usage. The rates shown are non-tobacco rates. These rates apply to applications submitted during the 6-month open enrollment or in a guaranteed issue situation. Applicants NOT enrolling during the 6-month open enrollment period or in a guaranteed issue situtaion will be evaluated for tobacco usage and charged the corresponding tobacco or non-tobacco rates. All rates are subject to change. Any rate change will apply to all members of the same class insured under your plan.

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.

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