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FREQUENTLY ASKED QUESTIONS

General Questions

Who is eligible for Senior Preferred? 
In order to be eligible for ProHealth Senior Preferred, you need to live in Waukesha County, Wisconsin.
Also, in order to be eligible for any Medicare Advantage program, including Senior Preferred, you must be eligible for Medicare Part A and enrolled in Medicare Part B.

What premium payment options do I have?
You can choose from three premium payment options including coupon book, automatic withdrawal from your bank account or automatic withholding from your Social Security check. Please note, we are not able to accept cash payments.

What if I have a question regarding a claim?
Contact Customer Service - you can review all of our contact information 
here.

Is my routine doctor's visit paid every 12 months or calendar year?
Senior Preferred members are eligible for one routine physical and vision exam every 12 months. If you have questions about the timing of your visit(s), please don't hesitate to contact Customer Service.


How do I find a doctor?
Refer to the
 
Provider Directory or contact Customer Service for assistance. 

How can I change my personal physician?
Contact Customer Service for
 assistance.

Am I covered when I am out of the service area?
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside the service area.
 

How do I get a new ID card?
Contact a Customer Service to get new ID cards mailed to you.


What rights and responsibilities do the Plan and I have upon disenrollment?
Please refer to your Evidence of Coverage to learn more about your rights and responsibilities. You can search for your plan documents, including the Evidence of Coverage, on this web page.

 

What is the difference between a Designated Representative and a Durable Power of Attorney? 
A Durable Power of Attorney (DPOA) allows one individual to make decisions on behalf of another. A DPOA remains effective for life unless it is revoked. There are two types of DPOA, one that applies to financial decisions and one that applies to health care decisions. A Designated Representative Authorization allows you to designate another individual to discuss your personal information. It does not allow the person to make decisions on your behalf. A Designated Representative Authorization remains in effect for two years unless revoked. You may also provide verbal consent to allow us to talk with another person you designate as your representative. However, your verbal consent is only valid on the day that it is given. If you would like to have another person continue to assist you, please submit a Designated Representative Authorization form to us.

Part D Prescription Drug Questions

What if I already have prescription drug coverage through Senior Care, Veterans Administration or a Retiree Plan? 
Anyone with current drug coverage through Senior Care, Veterans Administration (VA), Tricare, or a Retiree Plan can choose a Medicare Advantage plan without Part D drug coverage and avoid penalties if their drug coverage is at least as good or better than Medicare Part D coverage. Please contact Customer Service for further details.


Are over-the-counter drugs covered? 
Over-the-counter drugs are those that can be purchased without a prescription. Even with a prescription from your doctor, these drugs are not eligible for coverage with Senior Preferred. In addition, the cost of over-the-counter drugs is not applied to your yearly out-of-pocket maximums. 

What is my prescription coverage if I am out of the service area? 
Senior Preferred Part D drug coverage is processed through a pharmacy benefit manager. The Senior Preferred pharmacy benefit manager has contracts with over 55,000 pharmacies nationwide, which exceeds the Medicare access guidelines. Therefore, you will have coverage for prescription drugs outside of our service area as long as you choose a pharmacy contracted through ClearScript.
You can contact us to locate a pharmacy or use our 
online Provider and Pharmacy Directory (select the Pharmacy button).

Privacy Questions

What is HIPAA? 
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law that applies to both insurance companies and providers. HIPAA provides portability and continuity of health insurance coverage as well as protection of your personal health information. 

What do I do if I believe that my privacy rights have been violated? 
If you have questions or concerns about the way Senior Preferred has protected the privacy of your personal information, please contact the Privacy Specialist at (608) 881-8153.

This webpage was updated on September 27, 2016.