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Plus Point Plan (HMOPOS)
Plus Point Plan (HMOPOS) provides great benefits and the convenience of a local network of providers. Please review the benefits section links below. If you are interested in enrollment, check for your eligibility on the How to Enroll page or Enroll Online on our secure website. For more information, you are welcome to Contact Us or Send us an email.
Jump to: Benefits | Enrollment | Provider Directory | Prescription Drug Coverage | Value Added Service
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Benefits Information
- Benefit Highlights Guide – A brief overview of the most common plan benefits.
- Summary of Benefits – In-depth explanations of most plan benefits.
- Evidence of Coverage 2010 – A complete list of coverage and instructions for using your benefits.
- 2010 Monthly Plan Premium for People Who Get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
– Lists your amount of extra help if you qualify for a reduced premium.
Enrollment Information
- How to Enroll – This brochure provides enrollment instructions.
- Printable Enrollment Form – Use this form to enroll in a health plan.
Provider Directory
- Provider Directory – Lists all Doctors, specialists, hospitals, pharmacies, and other providers.
- Dental Provider Directory – Lists all Dental Providers in your area.
- Provider Online Search – Lists all Doctors, specialists, hospitals, pharmacies, and other providers.
- Dental Provider Online Search – Lists all Dental Providers in your area.
- Vision Provider Online Search – Lists all Optical Providers in your area.
Prescription Drug Coverage
- Formulary Drug List – All prescription drugs covered by your plan.
- Notice of Negative Formulary Change – Prescription drugs no longer covered by your plan.
- CareMark Pharmacy Mail Order RX Form – Print this form to fill your prescriptions by mail order.
- For more information on how to use prescription drug benefits, click here.
Ozark Health Plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. The formulary may change during the year and will be updated monthly on this website. Please see the Prescription Drug Frequently Asked Questions page for more information on Specialty Pharmacies used for ordering Tier 4 drugs.
Ozark Health Plan covers both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Value Added Service
As a Ozark Health Plan member you can participate in the SilverSneakers Fitness Program* at no additional cost! Regular physical activity is one of the best ways to improve muscle strength, balance, stability and energy levels and help decrease the risk of chronic diseases such as diabetes, osteoporosis and congestive heart failure. SilverSneakers can help you stay active so you can stay healthy. Take control of your health while you get fit, have fun and make friends!
Join SilverSneakers and receive free access to amenities such as treadmills, weights, heated pools and fitness classes that are included with a basic fitness center membership. You can take signature SilverSneakers classes** designed specifically for Medicare eligible and taught by certified instructors. As your fitness level progresses, you may be able to take advantage of additional SilverSneakers options available at selected fitness centers.
A designated fitness center staff member called a Senior AdvisorSM will help you all along the way. SilverSneakers members can also participate in health education seminars and fun social events with others who share your interest in a healthy lifestyle. Plus once you've enrolled in SilverSneakers you can use any participating location*** across the nation (eligibility for the SilverSneakers Fitness Program varies by benefit plan).
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*The Fitness Program is part of SilverSneakers, a value added health promotion service available only to members of Ozark Health Plan. Fitness Program eligibility varies by benefit plan. The Fitness Program is neither offered nor guaranteed under our contract with the Medicare program. In addition, the Fitness Program is not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Ozark Health Plan grievance process.
**Class offerings and services vary by location.
***A self-directed walking program, SilverSneakers Steps, is available for members living more than 15 miles from a participating fitness location.
Ozark Health Plan is provided by Arcadian Health Plan, Inc., Arcadian Health Plan, a Coordinated Care Plan with a Medicare Advantage contract. Anyone with Medicare Parts A and B, and residing in the service area of the plan, may apply. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. You can go to providers or hospitals in or out-of-network. You may have to pay more for the services you receive outside the network and you may have to follow special rules prior to getting services in and/or out-of-network. Limitations, monthly premiums, copayments and coinsurance will apply.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213, TTY/TDD users should call 1-800-325-0778, Monday - Friday, 7:00 a.m. - 7:00 p.m.; or your State Medicaid Office. You may not enroll in this plan if your current or former employer helps pay for your drugs.
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for 75% of drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or late enrollment penalty. Many people are eligible for these savings and don’t even know it. With Ozark Health Plan. your health care will be coordinated by you and your Primary Care Physician (PCP). If needed, your PCP will make a referral to a specialist or medical care providers who will help determine the best methods and treatments for your health care needs. Generally, you may only enroll in this plan during a certain time of the year. Please contact 1-800-653-2924 (TTY/TDD 1-866-573-8613), Sunday - Saturday, 8:00 a.m. - 8:00 p.m. for more information. Medicare beneficiaries may enroll in Ozark Health Plan through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov . For more information contact the Ozark Health Plan at 1-866-237-8901 (TTY/TDD 1-866-573-8613)
The plan is authorized by law to refuse to renew its contract with CMS, that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of the beneficiary’s enrollment in the plan. In addition, the plan may reduce its service area and no longer offer services in the area where the beneficiary resides.
Ozark Health Plan pharmacies include retail, mail order, and long term care. Mail order prescription drugs are available for up to a 90-day supply. All formulary drugs may be obtained through the mail order service.
Members have a right to appeal any decision the organization or plan makes regarding, but not limited to, a denial, termination, or reduction of services or benefits. This includes denial of payment for a service after the service has been rendered (post-service) or denial of service prior to the service being rendered (pre-service). Members may refer to the Evidence of Coverage for more information.
This information may be available in a different format. Please call Member Services at the number listed below if you need plan information in another format or language.
Members may enroll only during certain times of the year.
For full information on Ozark Health Plan, please call our Customer Service Department at 1-800-573-8597. Office hours are Mon-Sun 8 a.m. to 8 p.m., TTY/TDD: 1-866-573-8591.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2010. Please contact Plan Sponsor for details.