DISCOUNT MEDICAL PLAN MEMBER INFORMATION BOOKLET sheets v2... · 2010-03-15 · • Cosmetic dentistry • Crowns • Extractions • Fillings • Oral Surgery • Periodontics HOW

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THIS IS AN OPTIONAL NONINSURANCE PLAN.

VISIONHEARINGCHIROPRACTICDENTALPRESCRIPTION DRUGSVITAMINS & NUTRITIONAL SUPPLEMENTS24-HOUR NURSELINETRAVEL ASSIST"AUTOMATIC" CLAIMS FILING® PLUS

DISCOUNT MEDICAL PLAN MEMBER INFORMATION BOOKLETAVAILABLE TO CUSTOMERS WITH A MEDICARE SUPPLEMENT POLICY

This booklet and your other membership materials provide information (such as discount percentages) that is current as of March 2010.

For updated information on available discount medical services and maximums, please contact the participating location directly.

NOTE: PLATINUM SAVERS DISCOUNTS CANNOT BE USED IN CONJUNCTION WITH ANY OTHER DISCOUNT PLAN.

Disclosure: This plan is NOT insurance. This plan is optional. The plan provides discounts at certain health care providers for medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount medical plan organization. The range of discounts for services offered will vary depending on the type of provider and service. This is not a Medicare prescription drug plan. The licensed discount medical plan organization is Coverdell & Company, Inc., 8420 W. Bryn Mawr, Suite 700, Chicago, IL 60631, 1-866-440-0997, www.FindBestBenefits.com. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid.

Note to Texas Consumers: Regulated by the Texas Department of Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711; telephone 1-800-803-9202 or 1-512-463-6599; website:www.license.state.tx.us/complaints.

The plan does not meet the minimum credible coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.

THIS IS NOT INSURANCE AND THERE ARE NO FORMS TO FILE.

WELCOME PLATINUM SAVERS MEMBERThis is not insurance. This is an optional noninsurance plan available for a separate fee.

Carefully review your Platinum Savers discount medical plan membership materials which include this Platinum Savers member information booklet, your personalized Platinum Savers membership identification card and any additional convenient resource pamphlet(s).

HOW DO I ACCESS THE DISCOUNT MEDICAL PLAN?If you are having a prescription filled by a participating pharmacy, be sure to give the pharmacist your Platinum Savers membership identification card with the prescription. Present your Platinum Savers membership identification card when you arrive and again before paying for healthcare services or products.

WHAT IF I HAVE A QUESTION ABOUT THE DISCOUNT MEDICAL PLAN?Call toll free 1-866-440-0997 to speak to a customer service representative about the plan or to find participating locations. Even if you are traveling, our customer service representatives use a geographic locator program that will provide you with participating locations in that area. Just have the ZIP code or city name ready when you call.

DO YOU HAVE A WEBSITE I CAN USE TO FIND PARTICIPATING LOCATIONS?Yes, visit www.FindBestBenefits.com and enter the I.D. number printed on your identification card to find the participating vision, hearing, dental, chiropractic, or prescription retailer in your area.


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PLATINUM SAVERS DISCOUNT MEDICAL PLAN

VISIONPlatinum Savers offers its members 20% to 60% discounts on eyeglasses, contact lenses (excluding disposable), and other retail eye wear items through a network of more than 12,000 eye care professionals nationwide, including JCPenney, LensCrafters, Pearle Vision, Sears Optical and Target Optical. In addition, members can receive discounts of 10% to 30% on eye examinations and surgical procedures, including LASIK, where available. Most frames, lenses, and specialty items such as tints, scratch resistant coatings and ultraviolet protection are available. There are no limits on the number of times you may use the Platinum Savers vision discount during the year. Simply present your Platinum Savers membership identification card at the participating optical location and you will be eligible to receive the membership price. Since the Platinum Savers plan is not insurance, there are no forms to file.

HOW TO USE YOUR VISION DISCOUNT•To select a participating vision location, call 1-866-440-0997, or visit

www.FindBestBenefits.com and enter the I.D. number printed on your identification card.

•When calling a participating vision location for an appointment, tell them you are a member of the Coast to Coast vision network. Be sure to present your Platinum Savers membership identification card both when you arrive, and again before paying for any health care services or products.

• Select the eye wear and lenses of your choice. Almost all lenses, colors, sizes, and add-ons, such as ultraviolet protection, scratch coating, and tints are eligible for the Platinum Savers vision discount.

•There are no limits to the number of times you may use your Platinum Savers vision discount.


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Replacement Contact LensesReplacement contact lenses can be ordered through the mail order service with a 10% to 40% savings through Platinum Savers. •Call 1-800-878-3901 and give the operator the brand and type of lens you

use for a price quote over the phone. Most major brands of soft contact lenses are available including disposable, torics, bifocals and gas permeable lenses.

•Mail a valid doctor’s contact lens prescription to: America’s Eye Wear, P.O. Box 810255, Farmers Branch, Texas, 75381, and include your name and I.D. Number from your Platinum Savers membership identification card. You may place orders as often as you wish prior to the expiration date of the prescription.

• You can also fax a doctor’s contact lens prescription to 1-972-503-5671.•Most orders are received within seven to 14 days and can be paid for by Visa,

MasterCard, money order, or check.

30-Day Unconditional GuaranteeYour satisfaction is guaranteed. If for any reason you are not happy with a purchase at the retail locations or through the mail, return the merchandise within 30 days for an exchange or full refund. If you find a lower price anywhere else on the exact same pair of prescription eyeglasses purchased at a participating location within 30 days, the difference will be refunded.



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HEARINGPlatinum Savers hearing discounts are provided by one of the largest networks of audiologists in the United States. Platinum Savers offers its members savings on the following hearing services and products. Charges cannot exceed the maximums published in the following schedules.

Hearing Tests & Price Comparisons

SERVICEAVERAGE

PRICEPLATINUM SAVERS MAXIMUM CHARGE

YOU SAVE*

Comprehensive AudiometryPure-tone air and bone conduction, word recognition measures

$135 $49($59 in CA, NY)

$86

Acoustic Immittance Test Battery $114 $35 $79

Environmental Risk ConsultationDiscussion of daily noise exposure, recommendations for hearing protection

No Charge

Hearing Aid Evaluation $135 No Charge $135* All estimates are based on national average costs. Actual savings may vary per region.

Hearing AidsPlatinum Savers members receive a 10% to 20% savings from the participating location's usual fees on hearing aids (10% off programmable or digital hearing aids), hearing aid repairs, as well as related hearing products (excluding batteries). An additional charge may apply to an earmold for a Behind-the-Ear (BTE) Hearing Aid. There is no charge for an annual cleaning and check of hearing aids purchased through the Platinum Savers hearing discount. Any hearing aid not defined below is reduced 20% from the participating location's usual charge.

SERVICEAVERAGE

PRICEPLATINUM SAVERS MAXIMUM CHARGE

YOU SAVE*

In-The-Ear (ITE) $873 $670 $203

In-The-Canal (ITC) $1,051 $770 $281

Behind-The-Ear (BTE) $880 $695** $185

Programmable or Digital Hearing Aid Varies 10% Savings* All estimates are based on national average costs. Actual savings may vary per region.** Plus a custom earmold charge, if required.


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During the first year from date of delivery, the retailer will replace any hearing aid with the same model if it has been repaired three times or more through no fault of the Platinum Savers member. Platinum Savers members will also receive a free loaner during any repair period if the style permits. In addition, there are no dispensing fees for Platinum Savers members.An unconditional 45-day refund on hearing aids will be provided to the Platinum Savers member. However, the retailer shall be entitled to retain a fee of $35 per returned hearing aid plus a custom earmold charge, if required. Return policies vary from state to state.

HOW TO USE YOUR HEARING DISCOUNT•To select a participating location, call 1-866-440-0997, or visit


•When calling a participating location for an appointment, tell them you are a member of the HearUSA network. Be sure to present your Platinum Savers membership identification card both when you arrive, and again before paying for any healthcare services or products.



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CHIROPRACTICPlatinum Savers members have access to one of the largest networks of chiropractors in the United States. This chiropractic network provides Platinum Savers members with savings of 20% to 40% on their usual fees.SERVICE YOU PAY*

Consultation No ChargeExamination $35X-Rays - AP & Lat. Cervical $50 - AP & Lat. Thoracic $50 - Full Spine $150

* All estimates are based on national average costs. Actual savings may vary per region.

HOW TO USE YOUR CHIROPRACTIC DISCOUNT•To select a participating chiropractor, call 1-866-440-0997, or visit


•When calling a participating chiropractor for an appointment, tell them you are a member of the UNI-CARE chiropractic network. Be sure to present your Platinum Savers membership identification card both when you arrive, and again before paying for any healthcare services or products.



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DENTAL Platinum Savers members will realize significant savings on dental care expenses through one of the largest, independent networks of dental providers nationwide. Simply present your Platinum Savers membership card to any one of the more than 28,000 offices (including specialists where available) to receive discounted rates on dental procedures. You can save 10% to 50% on dental care expenses. When visiting a participating dental office, present your Platinum Savers membership identification card prior to treatment to be assured that the proper discount is applied. Participating offices and fees may change at any time.Platinum Savers is designed to save money not only on routine and preventive dental care, but also on more extensive dental treatments. Services available with Platinum Savers discounts include:

•Orthodontic (braces)•Dentures•Cosmetic dentistry•Crowns•Extractions• Fillings•Oral Surgery• Periodontics

HOW TO USE YOUR DENTAL DISCOUNT•To select a participating dental office, call 1-866-440-0997, or visit


•When calling a participating dental office for an appointment, tell them you are a member of the UNI-CARE dental network. Be sure to present your Platinum Savers membership identification card both when you arrive, and again before paying for any healthcare services or products.

NOTE: IF YOU HAVE A DENTAL INSURANCE PLAN THAT IS NOT A PPO OR HMO AND YOU SEE A PARTICIPATING DENTIST, YOU CAN USE YOUR PLATINUM SAVERS MEMBERSHIP CARD TO RECEIVE ADDITIONAL SAVINGS.

THIS IS NOT A PREPAID PLAN.


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PRESCRIPTION DRUGSPlatinum Savers offers immediate discounts on prescription drugs at participating pharmacies. Members can save an average of 20% off the retail price of prescription drugs with significant savings on generic drugs. Members can obtain savings at approximately 57,000 pharmacies nationwide.Members simply choose a participating pharmacy and present their Platinum Savers membership identification card to the pharmacist in order to receive a discount. The member’s cost for the medication will be the discount price offered through the plan or the pharmacy’s usual price, whichever is lower. Members are assured the lowest price in that store at the time the medication is purchased.

SOME MAJOR CHAIN PARTICIPANTS INCLUDE:ALBERTSON’S GIANT EAGLE PHARMACY SHOP ‘N SAVE PHARMACYANCHOR PHARMACY KERR DRUG SHOPRITE PHARMACYBI-LO PHARMACY KROGER DRUGSTORE SMITH’S PHARMACYBROOKSHIRE PHARMACY MEDICAP PHARMACY SUPER D DRUGSCOSTCO MEIJER PHARMACY TARGET PHARMACYCUB PHARMACY PATHMARK PHARMACY THRIFTY WHITE DRUGDILLON PHARMACY PHAR-MOR VONS PHARMACYDOMINICKS PHARMACY PRICE CHOPPER WALGREEN’SDRUG EMPORIUM PUBLIX PHARMACY WAL-MART PHARMACYFRED’S PHARMACY RITE AID PHARMACY WESTERN DRUGGENOVESE DRUG STORE SAFEWAY WINN-DIXIE PHARMACY

SHOPKO PHARMACY

PLUS THOUSANDS OF INDEPENDENT LOCATIONS

MAIL ORDER SERVICE You can use the mail order service anytime, but it is most convenient when ordering medication that is taken on a regular basis.

New PrescriptionsTo request a mail order form, call customer service at 1-866-440-0997. The mail order form will provide the address to which you will send your mail order form, an original written prescription from your doctor, and prepayment by check, money order, or credit card.


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RefillsIf a credit card is used, refills can be ordered by calling Caremark customer service at 1-877-321-2652 or visit their web site at www.caremark.com. If a check or money order is used, refills can be ordered with an order form. Please allow 14 days from the date you mail your order for delivery of your medication.Caremark will substitute an available generic equivalent for certain brand name drugs whenever allowed by your doctor and applicable pharmacy law. If you do not want a generic substitution for a specific medication, please note in the Comments section on the order form.

YOUR HEALTH AND SAFETY ARE IMPORTANTWhen you use a participating retail pharmacy or the mail service, the pharmacist’s expertise, the information provided by your physician, and your prior prescription history through the plan are combined to process your prescription. Real-time, point-of-service alerts, when indicated, are sent to your pharmacist with potential concerns about how your prescription may interact with other medications you are currently taking, your disease state, your age, etc. The alerts supplement your pharmacist’s professional evaluation, assisting the pharmacist to determine whether follow-up action with you and/or your doctor is necessary before dispensing the prescription.

HOW TO USE YOUR PRESCRIPTION DRUG DISCOUNT•To select a participating location, call 1-866-440-0997, or visit


•When visiting a participating retail location, tell them you are a member of the Caremark Prescription Services network. Be sure to present your Platinum Savers membership identification card both when you arrive, and again before paying for any healthcare services or products.



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VITAMIN & NUTRITIONAL SUPPLEMENTSPlatinum Savers members can obtain a wide range of vitamins and mineral supplements through the vitamin and nutritional supplement mail order plan at an average savings of 25% to 50% below already reduced catalog prices.

HOW TO USE YOUR DISCOUNT• Simply call 1-866-440-0997 to request a catalog. •Call the toll-free number listed in the vitamin and nutritional supplement

mail order catalog to place an order or to ask questions about the available supplements. Be sure to identify yourself as a Platinum Savers member to receive your discount.

Prescription drugs are not available through the vitamin and nutritional supplement mail order plan. Customer service representatives will be happy to answer any questions you might have about our products, but they do not offer any medical advice. Visit www.healthdirectonline.com to view a wide variety of products offered. Upon placing your first order online (minimum of $25), you can receive a free product by entering the promotion code DDS001. When ordering online, please have your Platinum Savers membership identification card available to be sure you receive the savings.



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24-HOUR NURSELINEPlatinum Savers members have unlimited access to registered nurses via a toll-free number 24 hours a day, 365 days a year. These nurses are specially trained to offer prompt, confidential medical counseling to help Platinum Savers members make informed decisions about health and medical care they receive. However, nurses do not diagnose or provide treatment.

HOW TO USE THE 24-HOUR NURSELINE•Call 1-800-982-2401 toll-free for confidential access to registered nurses

24 hours a day. Nurses can answer questions regarding: - self-care techniques for common symptoms - what to expect during a medical test - diagnostic and surgical procedures - a recently diagnosed medical condition - prescription and over the counter medication information

You can also go online to get valuable information on living healthy. Visit www.MyCareAllies.com and use bestbenefits as your login.


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TRAVEL ASSIST As a Platinum Savers member, you have access to Travel Assist when traveling more than one hundred (100) miles from your permanent residence. Call 1-888-965-9500 (or 1-410-257-9507 if outside North America). The service is available 24 hours a day, 365 days a year and provides multilingual customer representatives to assist members when they telephone. Members have access to the following services:

• Emergency evacuation/repatriation •Transportation of escort when the member needs emergency evacuation•Transportation of mortal remains — If a member dies while traveling over

100 miles from home his/her body will be transported back to the city of residence. See pamphlet for details.

• 24-hour information service is available to provide helpful facts before and during travel. Services include information on required documents, immunization requirements, State Department Travel Advisory warnings, weather and hazard information concerning foreign locations and more.

•Medical referral — Customer representatives can provide referrals to a local doctor or hospital when a member is traveling.

• Insurance coordination • Lost documentation service• Legal assistance•And much more as members will see.

HOW TO USE TRAVEL ASSIST If members are faced with a travel related emergency, contact Travel Assist (Mondial Assistance) first. An operator is immediately available to give support. Remember: In North America call 1-888-965-9500, or if outside of North America call 1-410-257-9507. Travel Assist is not available to residents of Connecticut or Florida.Your emergency travel service is fully outlined in the Travel Assist pamphlet. Please read carefully.

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"Automatic" Claims Filing® PLUSWhen you’re recovering from an illness, the last thing you want to deal with is filing your insurance paperwork. The optional Platinum Savers discount medical plan features a hassle-free claims filing service called “Automatic” Claims Filing PLUS (ACF PLUS), available only to the primary plan member with a Liberty National Life Insurance Company Medicare Supplement policy.

5 GREAT REASONS TO HAVE ACF PLUS1. Save time — ACF PLUS virtually eliminates claims filing paperwork. 2. With ACF PLUS, we receive your Medicare claims information electronically.

This means we may process the benefit check for the healthcare provider before you receive your Medicare Summary Notice form from Medicare.

3. ACF PLUS pays benefits directly to healthcare providers accepting Medicare assignment … policyholders do nothing!

4. ACF PLUS helps prevent lost or misfiled claims so all eligible benefit dollars due under the policy are paid.

5. With ACF PLUS, we arrange to receive all claims filed with Medicare Part B administrators electronically. Without ACF PLUS, certain claims for Medicare participating providers will be sent directly to us. However, policyholders may need to file other claims manually in order to receive benefits.

IF YOU DECIDE TO NO LONGER PARTICIPATE IN “AUTOMATIC” CLAIMS FILING PLUS, PLEASE NOTIFY THE COMPANY BY TELEPHONE OR IN WRITING. YOUR CLAIMS WILL CONTINUE TO BE RECEIVED AUTOMATICALLY WHILE THE REQUEST IS IN PROCESS.

For use as an informational booklet only. Booklet is not for solicitation of insurance.

DISCOUNT MEDICAL PLAN MEMBER INFORMATION BOOKLET sheets v2... · 2010-03-15 · • Cosmetic dentistry • Crowns • Extractions • Fillings • Oral Surgery • Periodontics HOW

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