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To speak with a friendly Alliance CompleteCare representative, call: Toll-free: 1-877-585-7526 CRS for hearing impaired: 711 or 1-800-735-2929 8 a.m. - 8 p.m., 7 days a week

Eligibility to enroll
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. You must have Medicare Parts A and B, and must reside in Alameda County, the service area of the plan. You must have Medi-Cal in addition to Medicare to enroll in the plan.

Provider network
You must receive all routine care from plan providers who have an arrangement with Alliance CompleteCare. Your primary care provider will provide or arrange for most of your covered services. Routine care or services you get from providers who are not part of Alliance CompleteCare will not be covered, with few exceptions such as emergencies, urgent care, and out-of-area dialysis.

Low Income Subsidy (LIS) also called "Extra Help" for People with Limited Incomes: extra help from Medicare for prescription drug costs
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, call: 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week; TTY/TDD users should call 1-877-486-2048; Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday; TTY/TDD users should call-1-800-325-0778, or visit *www.socialsecurity.gov *Clicking this link will take you away from Alliance CompleteCare web page to a site that may not be MediCare-specific.; or the Alameda County Medi-Cal Office at 1-800-698-1118; TTY/TDD users should dial 711.

If your Medicaid (Medi-Cal) status changes
If your Medi-Cal status changes, we advise you to contact your Medi-Cal eligibility technician at Social Services about your eligibility issue or renewal. By law, the Alliance cannot intervene in Medi-Cal eligibility issues. Members must address eligibility with Social Services directly. Call the Alameda County Social Services Agency, Medi-Cal Center at:
Phone: 510-777-2300
Toll Free: 1-800-698-1118
TTY for hearing impaired: 711

Best Available Evidence (BAE)
You can use the BAE to show that you qualify for the Low Income Subsidy (LIS). For more information on LIS and BAE, visit the Best Available Evidence Policy on the Medicare Web site (by clicking on this link you are leaving our Web site).

Pharmacy network
The pharmacy network includes retail, mail order, long-term care, home infusion, and specialty pharmacy services. For information about mail order, names and addresses of network pharmacies or for more information about benefits, call Alliance CompleteCare toll-free at 1-877-585-PLAN (7526); TTY users can call 1- 888-747-1574, 7 days a week, from 8 a.m. to 8 p.m.

Description of out-of-network coverage
You must use a network pharmacy to receive plan benefits. You may be able to have access to covered drugs dispensed at out-of-network pharmacies if you are unable to obtain a covered drug at a network pharmacy in a timely manner within our service area and you are not accessing out-of-network pharmacy services on a routine basis.

Potential for contract termination
The plan’s contract with CMS is renewed annually. Availability of coverage beyond the end of the current contract year is not guaranteed. Alliance CompleteCare is offered by Alliance for Health, a health plan with a Medicare contract.

Enrollment and disenrollment
If you have Medicare and Medi-Cal, you can join Alliance CompleteCare at any time. Medicare beneficiaries may enroll in Alliance CompleteCare through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. *Clicking this link will take you away from Alliance CompleteCare web page to a site that may not be MediCare-specific. Beneficiaries may join, switch, or drop a Medicare Advantage plan only during specified times of the year, except in certain situations. Some of these situations include the following:

• If you move out of your plan’s service area
• If you have both Medicare and Medicaid
• If you qualify for “extra help”
• If you live in an institution

For more information, call the Care Advisor Unit at 1-877-585-PLAN (7526) or TTY 1-888-747-1574, 7 days a week, 8 a.m. - 8 p.m.

Alliance CompleteCare’s Prescription Drug Benefit is only available to enrollees of Alliance CompleteCare. By enrolling in our plan, you will be disenrolled from your former plan—and you must obtain all your medical and prescription drug coverage through the Alliance.


Member rights & responsibilities upon disenrollment
Ending your membership in Alliance CompleteCare may be voluntary (your own choice) or involuntary (not your own choice).

There are also limited situations where you do not choose to leave, but we are required to end your membership.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.

When can you end your membership in our plan?
You may end your membership in our plan at any time of the year. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the Medicare Advantage Annual Disenrollment Period. Since all Alliance CompleteCare members have Medi- Cal, you may also leave the plan at other times of the year, such as during:
The Annual Enrollment Period (From November 15 to December 31 in 2010)
The Medicare Advantage Annual Disenrollment Period (Every year from January 1 to February 14)
A Special Enrollment Period (The enrollment periods vary depending on your situation)

To learn more, visit the Medicare website: http://www.medicare.gov. *Clicking this link will take you away from Alliance CompleteCare web page to a site that may not be MediCare-specific.

How to voluntarily end your membership in our plan?
Usually, to end your membership in our plan, you simply enroll in another health plan during one of the enrollment periods. One exception is when you want to switch from our plan to Original Medicare without a Medicare prescription drug plan. In this situation, you must contact Alliance CompleteCare Member Services and ask to be disenrolled from our plan.

If you would like to switch from our plan to Another Medicare Advantage Plan, enroll in the new Medicare Advantage plan. You will automatically be disenrolled from Alliance CompleteCare when your new plan’s coverage begins.
If you would like to switch from our plan to Original Medicare with a separate Medicare prescription drug plan, enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from Alliance CompleteCare when your new plan’s coverage begins.
If you would like to switch from our plan to Original Medicare without a separate Medicare prescription drug plan, contact Member Services and ask to be disenrolled from the plan.

You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048. You will be disenrolled from Alliance CompleteCare when your coverage in Original Medicare begins.

Until your membership ends, you must keep getting your medical services and drugs through our plan.
If you leave Alliance CompleteCare, it may take time before your membership ends and your new Medicare coverage goes into effect. (See Section 2 of the Alliance CompleteCare Evidence of Coverage (EOC) for information on when your new coverage begins.) During this time, you must continue to get your medical care and prescription drugs through our plan. You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services. If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).

When must Alliance CompleteCare end your membership in the plan?
Alliance CompleteCare must end your membership in the plan if any of the following happens:
If you do not stay continuously enrolled in Medicare Part A and Part B.
If you move out of our service area for more than six months.
If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area.
If you become incarcerated.
If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.
We cannot make you leave our plan for this reason unless we get permission from Medicare first.
If you let someone else use your membership card to get medical care.
If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
You do not meet the plan’s special eligibility requirements as stated in Chapter 1, section 2.1. of the Alliance CompleteCare EOC.
If you lose having full Medi-Cal benefits with no share of cost and do not regain it within 6 months.

If your Medicaid (Medi-Cal) status changes
If your Medi-Cal status changes, we advise you to contact your Medi-Cal eligibility technician at Social Services about your eligibility issue or renewal. Call the Alameda County Social Services Agency, Medi-Cal Center at:
Phone: 510-777-2300
Toll Free: 1-800-698-1118
TTY for hearing impaired: 711

We cannot ask you to leave our plan for any reason related to your health
If you feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership. You can also look in Chapter 9, Section 10 of the Alliance CompleteCare EOC for information about how to make a complaint.

How to obtain the total number of grievances, appeals and exceptions
You may contact the Alliance Care Advisor Unit to obtain information on the total number of grievances, appeals, and exceptions filed with Alliance CompleteCare.

Contact Information
Alliance CompleteCare
1240 South Loop Road
Alameda, CA 94502

Toll-free: 1-877-585-7526
CRS for hearing impaired: 711 or 1-800-735-2929
8 a.m. to 8 p.m., seven days a week
www.alliancecompletecare.org