Preferred Gold without part d (HMO-POS)**

• Summary of Benefits
• Annual Notice of Change/Evidence of Coverage (contract) without Part D
• 2017 Medicare Plan Ratings (Stars)

What you get with Preferred Gold:

• No specialist referrals.
• Worldwide coverage for emergency room and urgently needed care.
• 22,000 MVP doctors and hospitals, from Buffalo, NY to Burlington, VT.
• Freedom to see any doctor (you may pay more for doctors who are not contracted with MVP).
• Full coverage for preventive care, like Annual Wellness Visits and mammograms.
• A Healthways SilverSneakers Fitness Program membership, at no added cost to you!
• $75 Wellness Rewards for staying current with yearly exams, tests and screenings.
• Being able to connect with a health care professional online when you cant get to your doctor, its after hours, or youre traveling.
• A dedicated team experienced in Medicare Advantage health plans.

Note: If your coverage is through an employer sponsored plan, all benefits may not apply.

SilverSneakers^® is a registered trademeark of Healthways, Inc.

**Note: Preferred Gold without Part D does not include coverage for prescription drugs. If you do not have prescription drug coverage as good as Medicare's (called creditable coverage) you may have to pay a penalty if you join a plan with Part D at a later date. You cannot enroll in both Preferred Gold without Part D and a separate Part D plan Medicare will automatically disenroll you from Preferred Gold without Part D and enroll you into the Original Medicare (Parts A and B only) health plan for your medical coverage.

MVP Health Plan, Inc. is an HMO-POS/PPO/MSA organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

HMO-POS members may see doctors within and outside the MVP network. However, with the exception of emergencies or urgent care, it will cost more to get care from out-of-network providers.  You must use network pharmacies to access your prescription drug benefit.

Last updated: October 2016