Footnotes
1. One Pass® is a registered trademark of One Pass Solutions, Inc. in the U.S. and other jurisdictions and is a voluntary program. Continue at [1]
2. Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Any unused amounts are forfeited upon disenrollment from our plan. The cost of eligible OTC items will be covered up to the balance available on your card. If there is a remaining amount to pay, you must use another form of payment. Continue at [2]
3. Rides may be provided by taxis, rideshare services, vans, and medical transport as determined by our transportation provider. Limited to 65 miles, one way. Continue at [3]
4. This number can be dialed from both inside and outside the United States. Before the phone number, dial "001" for landlines and "+1" for mobile lines if you’re outside the country. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day, July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday at 4 a.m. PT. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Continue at [4]
5. In-home support is offered within the base plan for D-SNP plan members only. Core, Bronze, Silver, Enhanced, Gold and PPO Choice members may receive this benefit by purchasing Advantage Plus options. Continue at [5]
Kaiser Permanente is an HMO, HMO-POS, and PPO plan with Medicare contracts. Enrollment in Kaiser Permanente depends on contract renewal.
The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the grievance process.