Disclaimers

This Evidence of Coverage (2017 & 2018) is part of our contract with you about how Golden State Medicare Health Plan covers your care. Other parts of this contract include your enrollment form, the List of Covered Drugs (Formulary), and any notices you receive from us about changes to your coverage or conditions that affect your coverage. These notices are sometimes called “riders” or “amendments.”

The contract is in effect for months in which you are enrolled in Golden (HMO) between January 1 and December 31.

Medicare must approve our plan each year

Medicare (the Centers for Medicare & Medicaid Services) must approve Golden (HMO) each year. You can continue to get Medicare coverage as a member of our plan only as long as we choose to continue to offer the plan for the year in question and the Centers for Medicare & Medicaid Services renews its approval of the plan.

Availability of Non-English Translations Plans/Part D Sponsors

This information is available for free in other languages. Please contact our customer service number at (877) 541-4111 or TTY at (877) 551-4111 from 8 a.m. to 8 p.m. Monday through Friday and daily during the enrollment period.

Esta información está disponible de forma gratuita en otros idiomas. Por favor, póngase en contacto con nuestro número de servicio al cliente al (877) 541-4111 o TTY al (877) 551-4111 de 8 am a 8 pm de lunes a viernes, y todos los días durante el período de inscripción.

Operational Hours

Golden State Medicare Healthcare Plan has the following office hours of 8:00AM to 8:00PM Monday through Friday.

During Enrollment Periods and Disenrollment Periods, Golden State Medicare Healthcare Plan’s operational Hours are from 8:00AM to 8:00PM Monday through Sunday.