EOC VIP RX CH

EmblemHealth

PDF EOC VIP RX CH
2021  1  1   2021  12  31 

 (VIP Rx) (PDP)  Medicare
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// 2022  1  1 
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OMB  0938-1051 2021  12  31 

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Section 1.1

We must provide information in a way that works for you (in languages other than English, in braille, in large print, or other alternate formats, etc.)

To get information from us in a way that works for you, please call Customer Service (phone numbers are printed on the back cover of this booklet).
Our plan has people and free interpreter services available to answer questions from disabled and non-English speaking members. Information is available for free in other languages. We can also give you information in braille, in large print, or other alternate formats at no cost if you need it. We are required to give you information about the plan's benefits in a format that is accessible and appropriate for you. To get information from us in a way that works for you, please call Customer Service (phone numbers are printed on the back cover of this booklet.)
If you have any trouble getting information from our plan in a format that is accessible and appropriate for you, please call to file a grievance with Customer Service (phone numbers are printed on the back cover of this booklet). You may also file a complaint with Medicare by calling 1-800-MEDICARE (1-800-633-4227) or directly with the Office for Civil Rights. Contact information is included in this Evidence of Coverage or with this mailing, or you may contact our plan's Customer Service for additional information.

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 (HIICAP) (New York's SHIP)

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New York State Office for the Aging 2 Empire State Plaza Albany, New York 12223-1251



http://www.aging.ny.gov

PRA  1995  OMB  OMB  0938-1051CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


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