Member Claims Information

Our Member information and materials provide you with the tools, information and resources to help you get the most out of your Signature Advantage benefits and coverage and much more.

You can view your provider directory, find information about your member benefits, and access important information and documents about your prescription drug coverage.

To learn about the benefits and coverage provided by Signature Advantage, read your Evidence of Coverage. To request a hard copy of the Signature Advantage Plan provider directory, please call Member Services at (844) 214-8633. Please include your phone number and the mailing address where the provider directory should be sent.

• It gives details about the health care services and prescription drugs we will cover.
• It tells you how to get your health care and prescription drugs as a Signature Advantage Member.
• It also explains the rights, benefits, and responsibilities of Members.
• If you prefer, you can request printed copies of the information you want. Just contact us.

Filing a Grievance

 Grievance is any complaint, other than one that involves a request for an initial determination or an appeal. This type of complaint does not involve coverage or payment disputes.

Grievances do not involve problems related to approving or paying for medical care, services, Part D or non-Part D drugs; problems about having to leave the hospital too soon; or problems about having Skilled Nursing Facility (SNF) services ending too soon.

Problems that may lead to a grievance include:

• Dissatisfaction with the service you receive from Member Services
• You feel that you are being encouraged to leave (disenroll from) the Plan
• You believe our written materials are hard to understand
• Waiting too long for prescriptions to be filled
• Problems getting appointments when you need them or waiting too long for them
• Rude behavior by our staff
• We fail to respect your rights
• You disagree with our decision not to give you a “fast” decision or a “fast” Appeal
• We don’t give you a decision within the required time frame

If you have one of these types of problems and want to make a complaint, it is called “filing a Grievance.” For more information about filing a grievance, please read Important Plan Information or you can call us at 1-844-214-8633 (TTY 711). Calls to this number are free. Our hours are 8 a.m. to 8 p.m., seven days a week from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.

See your Evidence of Coverage for more information about grievances and appeals.

If you would like to send a complaint directly to Medicare, you may do so by filling out the Medicare Complaint Form online.

Filing an Appeal

An appeal is when you want us to reconsider a decision we have made about your coverage.

If you disagree with the decision, you have the right to appeal. Information on how to ask for an appeal and the timeframe in which an appeal must be filed are stated in the denial letter.

Examples of appeals include:

• Our decision not to cover a drug or medical benefit.
• Our decision not to reimburse a medical service or a drug you paid for.
• Our denial of a coverage determination.

For more information about filing an appeal, please read Important Plan Information or you can call us at 1-844-214-8633 (TTY 711). Calls to this number are free. Our hours are 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.

Appoint a Representative

Requesting an Aggregate Number of Grievances, Appeals & Exceptions

You have the right to request the number of appeals and the number of quality of care grievances received by Signature Advantage (HMO SNP) during a plan year.

Please call Member Services at 1-844-214-8633 (TTY 711). Calls to this number are free.

Our hours are 8 a.m. to 8 p.m., seven days a week from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.

Ending Your Signature Advantage Benefits

Ending your Membership in Signature Advantage may be voluntary (your own choice) or involuntary (not your own choice). If you are leaving our plan, you must continue to get your medical care through our plan until your Membership ends.

Your disenrollment will usually be effective on the first day of the month after we receive your request to end your Membership. You can choose another Medicare health plan or Original Medicare. Your enrollment in your new plan will begin on the first day of the month after you end your enrollment with us.

For more complete information about disenrolling from Signature Advantage, you can do any of the following:

• See your Evidence of Coverage
• Call Signature Advantage at 1-844-214-8633 (TTY 711). Calls to this number are free. Our hours are 8 a.m. to 8 p.m., seven days a week from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.
• Read the Medicare & You Handbook. Everyone with Medicare receives a copy of Medicare & You each fall. Those new to Medicare receive it within a month after first signing up. You can also download a copy from the Medicare website (www.medicare.gov). Or, you can order a printed copy by calling Medicare at the number below.
• Contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Calls to these numbers are free.