Sterling Health Plans. Real people. Wise choices

Plan Member

At Windsor Health Plan^SM, we understand that there are many different choices of insurance companies available to help cover your health care needs. Thank you for choosing us.

Windsor Medicare Extra Information

• Member Handbook 
• Find your plan information
• Find a provider or facility
• Find your drugs (MAPD formulary)
• Drug Safety Notices
• Drug Archive 

Find a pharmacy

• Alabama 
• Arkansas
• Idaho 
• Mississippi  
• Montana 
• South Carolina 
• Tennessee 
• Virginia

Medication Therapy Management Program

• Medication Therapy Management Program (MTMP) 
• MTMP Personal Medication List | Español

Member forms and documents

• Authorization to Release Protected Health Information Form
• CMS Appointment of Representation Form (Form CMS-1696) 
• Coverage Determinations and Exceptions 
• Coverage Determinations Form 
• Dental Enrollee Submitted Claim Form: Diamond and Fusion Plans
• Disenrollment Rights and Responsibilities
• FAQ  
• Grievance and Appeal Form 
• Health Assessment Form 
• How to Spot and Report Medicare Fraud and Abuse  
• Individual Account Bank Draft Form
• Individual Credit Card Form
• Medical Claim Form  
• Medical Release Form 
• Medicare Complaint Form
• Part D Coverage Provider Determination Request Form
• Physicians Appeals and Grievances  
• Preventive Screening Checklist and Chronic Disease Management 
• Scope of Appointment Form 
  
  

  Complete forms should be mailed to:

  Windsor Medicare Extra
  Attention: Customer Service
  7100 Commerce Way Suite 285
  Brentwood, TN 37027
  
  Or fax to: Customer Service: 615-782-7828
  
  

  Find your plan and key documents. See Chapter 9 of your plan’s Evidence of Coverage (EOC) for information about the grievance, coverage determination (including exceptions), and appeals processes.

How do I get my flu shot reimbursement?

Windsor Health Plan, Inc. members who have paid out of pocket for their flu shots can send their flu shot receipts and claims to the following location. A fax number is also listed.

Windsor Medicare Extra
Member Reimbursement
P.O. Box 269025
Plano, TX 75026-9025 

Mailroom Fax Number: (972) 739-9154

What are the BIN and PCN numbers for 2013?

Our BIN number for processing pharmacy claims is 012320. The PCN is MEDDADV.  

What diabetic meters and testing supplies are covered under my plan?

We cover the ACCU-CHEK products (ACCU-CHEK Aviva, ACCU-CHEK Compact Plus, ACCU-CHEK Nano) at no charge to you. All other brands will require a prior authorization and if approved, will be covered at your Part B diabetic supply coinsurance.

Not only is the ACCU-CHEK meter covered at no cost, it is supported by the ACCU-CHEK Customer Care Service Center, which is available 24 hours a day to serve your needs. That includes a toll-free number, Web site and customized e-mails on topics of interest to you, if you choose. You also have access to important diabetes information, news, troubleshooting tips and answers to questions, as well as complete instructions on using your new meter at https://www.accu-chek.com/index.html or through calling 1-888-355-4242.

Find your plan and key documents. See Chapter 9 of your plan’s Evidence of Coverage (EOC) for information about the grievance, coverage determination (including exceptions), and appeals processes.

 

About Enrollment

Members may enroll in the plan only during specific times of the year. Contact Windsor Medicare Extra for more information: 1-800-316-2273, TTY 711, 8 a.m. – 8 p.m. seven days a week.

Medicare beneficiaries may also enroll in Windsor Medicare Extra plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

Members must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday. TTY users should call 1-800-325-0778 or your Medicaid Office.

Windsor Health Plan is a Medicare Advantage organization with a Medicare contract and a contract with the Alabama, Arkansas, Mississippi, Montana, South Carolina, Tennessee and Virginia Medicaid programs.