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EVIDENCE OF COVERAGE Page 1 EVIDENCE OF CÎVERAGE Your Medicare prescription drug coverage as a Membår of TEAMStar Medicare Part D Prescription Drug Coveragå January 1 Á December 31, 2008 This Evidence of Coveragå gives the details about your Medicare presñription drug coverage. It is an important legal document. Pleaså keep it in a safe place. TEAMStar Medicare Part D Customer Servicå: For help or information, please call Customer Serviñe 8am to 8pm EST/EDT. Calls to these numbers are freå: Claims Questions: 1-800-797-9791 Other Custîmer Service: 1-866-524-4173 TTY/TDD: 1-866-524-4174 Web sitå: www.teamstarpartd.com E-mail: medicarepartdteamstar.com Hours of Operatiîn: 8:00am to 8:00pm EST/EDT. E065408EOC F6117 Page 2 Page 3 3 Table of Contents Sectiîn 1 Introduction......................................................................................................................................................................................... 5 Section 2 How You Get Outpatient Prescription Drugs (Part D).................................................................................................... 10 Section 3 Prescription Drug (Pàrt D) Benefits......................................................................................................................................... 14 Section 4 Your Costs for Our Plàn................................................................................................................................................................ 18 Section 5 Your Rights and Responsibilities as a Membår of our Plan......................................................................................... 25 Section 6 General Exclusions......................................................................................................................................................................... 27 Señtion 7 How to File a Grievance............................................................................................................................................................... 28 Section 8 What to Do if You have Complaints abîut Your Part D Prescription Drug Benefits.......................................... 30 Section 9 Ending your Membårship........................................................................................................................................................... 41 Section 10 Legal Notices.................................................................................................................................................................................... 42 Section 11 Dåfinitions of Some Words Used in This Book................................................................................................................... 43 Section 12: State Assistancå Organizations
