By completing and submitting an online enrollment form, you are actually sending us an application to join MediGold. If this is not your intention, do not complete or submit the online form. By enrolling in MediGold, you must keep your Medicare Parts A and B, abide by the plan's membership rules, as outlined in member materials, consent to the disclosure and exchange of information necessary for the operation of the plan, understand that you can only be enrolled in one Medicare health plan and that enrollment in MediGold automatically disenrolls you from any other Medicare health plan and prescription drug plan, and that you have the right to appeal service and payment denials made by the organization.
If you are enrolling in MediGold Medical Only (HMO), please read the following: MediGold Medical Only (HMO) is an option for those who do not wish to have prescription drug benefits from any company or those who have credible Part D coverage through a past employer or the Veterans Administration, for example. You may not privately purchase separate stand-alone Part D drug benefits from another company while enrolled in MediGold Medical Only (HMO). If you wish to have Part D drug benefits, consider MediGold Essential Care (HMO), MediGold Classic Preferred (HMO), MediGold Network Choice (PPO) or MediGold Value Choice (PPO). Individuals who are without credible Part D drug benefits may be subject to penalties if they purchase Part D drug benefits at a later time. Feel free to speak with us for more information about MediGold Medical Only (HMO) before making your enrollment decision.
If you are enrolling in MediGold Network Choice (PPO) or MediGold Value Choice (PPO), please read the following: MediGold's PPO plans provide benefits for covered services when received from in or out-of-network providers. As a member of these plans, you are assured access to in-network providers for covered care. Out-of-network providers may also be used, though out-of-network providers reserve the right to accept or deny PPO members. Services received from out-of-network providers will generally cost you more than if you use in-network providers.
For information regarding your rights and responsibilities upon disenrollment, please refer to the Evidence of Coverage.
Learn how you can appoint a representative to act on your behalf.
Medicare beneficiaries may also enroll in MediGold through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at http://www.medicare.gov (by clicking this link, you will be leaving MediGold's website). For more information, please contact MediGold.
Last Updated 1/2/2013 1:34:15 PM