Articles
How to file a grievance or appeal a coverage decision?
Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage) To file or check the status of a grievance or an appeal‚ contact us at: Grievances: (800) 965-4022, 8 a.m. to 8 p.m., Monday through Friday, TTY/TDD 711 Appeals:...
How do I request a coverage determination or medical exception for a drug?
You, your authorized representative, or your prescribing doctor can ask for a coverage determination. Mail us a Coverage Determination Request Form to: Simplete 3310 Fields South Drive Champaign, IL 61822 Call us at (800) 851-3379 , option...
How can I change or cancel / disenroll from my plan?
Changing Plan Types The Annual Enrollment Period (AEP) is the time each year, chosen by the Centers for Medicare and Medicaid Services (CMS), when you can enroll in a plan or switch to a new one. Unless you qualify for a Special Enrollment Per...
What are my rights and responsibilities upon disenrollment?
If you decide to disenroll from your Simplete Medicare Advantage plan, you are ending your membership. Disenrollment can be voluntary (your choice) or involuntary (not your choice). For more information on enrollment or disenrollment, see your Evide...
National Coverage Determinations
When the Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered, they update them through National Coverage Determinations. Learn more about National Coverage Determinations on their website . CMS has issued t...
Specific Drug Requirements
Certain covered drugs have special rules or limits, like step-therapy, preauthorization, and quantity limits, to keep you safe. Learn more about these and which drugs have them. How do I request a coverage determination or medical exception for a ...