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An organization determination is a decision your health plan makes regarding a request by you, your authorized representative or a physician for the Plan to cover health services, a payment request of a claims for services you have already received or increased coverage for services you are already receiving.
A drug coverage determination is a decision our plan makes about the coverage of a Part D drug or the amount our plan will pay for your Part D prescription drugs. This includes asking our plan to make an exception to the way a drug is covered.
You may end your membership during certain times of the year, known as enrollment periods. All members have the opportunity to request to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Open Enrollment Period.