2017 Medicare Select | Enrollment Instructions and Forms | Denver Health Medical Plan

2017 Medicare Select | Enrollment Instructions and Forms

Google Translate -- Select a Language

Members may enroll in most plans only during specific times of the year. However, members who qualify for a Special Election Period (SEP) may be able to enroll in the plan throughout the year. Dual eligible SNP (Special Needs Plan) members can enroll at any time. Members who wish to enroll in a Five-Star Rating plan, may enroll at any time however they may do so only once per year. For more information, please contact our Member Services at 303-602-2111 or toll free 1-877-956-2111. TTY users should call 711. Our hours of operation are 8 a.m. - 8 p.m. seven days a week.

Click here for Enrollment Form

Click here for Enrollment Form in Spanish

You can download these forms and fax to our Enrollment Department at 303-602-2099, and one of our licensed brokers will get in contact with you to complete the enrollment process. If you would like to discuss your personal situation, our insurance consultants are available Monday - Friday. All consultants are salaried Denver Health employees. You can call our Member Services at the number listed above in the first paragraph of this page to contact one of our consultants.

Medicare beneficiaries may also enroll in Medicare Select (HMO) through the CMS Medicare Online Enrollment Center (OEC) located at www.medicare.gov.

Click here for our Medicare Select Summary of Benefits.

Click here for our Star Ratings.

Click here for our Star Ratings in Spanish.

Click here for our Multi-Language Interpreter Services

Please be aware that Plan benefits and cost-sharing may change from year to year. It is possible that a Plan may not be available to beneficiaries the following contract year because, by law, Plan Sponsors may choose to not renew their contact with CMS - or, CMS may also refuse to renew the contact, thus, resulting in a termination or non-renewal.

Please note! You may only enroll in one Medicare Advantage Prescription Drug plan at a time and you may join or leave a Medicare Advantage Prescription Drug Plan during certain times of the year.

For information about premium and the 'Extra Help' program, click on the LIS Premium Subsidy on the left of this page.

To remain a member of our Medicare Advantage Plan, you must continue to keep Medicare Part A and Part B.

Click here for information about other plans in your area via the Medicare Prescription Drug Plan Finder.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.

These documents may be available in alternate formats or languages. For more information, please contact our Member Services department at 303-602-2111 or toll free at 1-877-956-2111. TTY users should call 303-602-2129 or toll free at 1-866-538-5288. Our hours of operation are 8 a.m. - 8 p.m. seven days a week.

Este documento podría estar disponible en otros formatos o idiomas adicionales. Para obtener más información, por favor comuníquese con Servicios al Afiliado al 303-602-2111 o llame gratis al 1-877-956-2111. Los usuarios TTY/TDD favor de llamar al 303-602-2129 o gratis al 1-866-538-5288. Estamos disponibles de las 8 a.m. a las 8 p.m. los siete días de la semana.

If it is found that you are not entitled to Medicare Part A and Part B at the time coverage begins and you have used the plan’s services after the effective date, then you may be financially liable for those services.

  • Members of Medicare Choice and Medicare Select agree to abide by the plan’s membership rules as outlined in the Evidence of Coverage.
  • Members of Medicare Choice and Medicare Select must obtain services and care through designated providers within the plan’s network except for emergency services and urgently needed care.
  • Members are responsible for any premiums, deductibles, coinsurance or copayments, where applicable.
  • Members have the right to appeal service and payment denials made by Denver Health Medical Plan.
  • Prospective members must give their consent for the exchange and disclosure of necessary information for treatment, payment and operations between Denver Health Medical Plan and the Centers for Medicaid and Medicare Services.
  • You must agree to pay your Medicare Part B premium.
  • You may not join our Medicare plan if you have End-Stage Renal Disease unless you had a successful kidney transplant and your doctor shows you no longer need dialysis.
  • Denver Health Medical Plan renews its contract with the federal government annually. Coverage beyond the end of the contract period cannot be guaranteed.

Rights and Responsibilities upon disenrollment

Your rights and responsibilities upon disenrollment:

  • You must continue to use network providers and pharmacies until you are disenrolled from our plan.
  • You may only disenroll or switch plans under certain circumstances.
  • You have the right to make a complaint if we ask you to leave our plan.

Our rights and responsibilities upon your disenrollment

We will let you know, in writing, the date your coverage ends. We have the right to disenroll you for the following reasons:

  • You are no longer eligible for Medicare Part A and/or B or Medicare prescription drug coverage.
  • If we are no longer contracting with Medicare or we leave your service area.
  • Your move out of our service area permanently or for more than six months.
  • You fail to pay your plan premium.
  • You provide fraudulent information when you enroll or let someone else use your enrollment ID card to get covered services.