Viva Medicare Extra Care (HMO SNP)

My Membership

Getting Help from Viva Medicare

Member Services

Our Member Services staff is here to help if you have questions, concerns, or problems. You can reach Member Services at 205-918-2067 in Birmingham or 1-800-633-1542 toll free. TTY users, please call 711. Regular office hours are from 8 am - 8 pm, Monday through Friday. Extended office hours (Oct. 1 - Mar. 31) are from 8 am - 8 pm, 7 days a week. You can also send a fax to us at 205-558-7414 or write us at:

Viva Medicare
417 20th Street North
Suite 1100
Birmingham, AL 35203

Your health and satisfaction are important to us. You can contact Member Services to check the status of a request or to ask questions about our processes. Member Services can also help you make a request for a coverage decision or file a complaint or appeal.

Why is Viva Calling Me?

Viva Medicare reaches out to our members for many reasons. We want to help you maintain your health and make sure you’re getting the most out of your benefits. When you receive a call from Viva Medicare, it will be from one of our nurses, pharmacists, employees, or a trusted vendor. You may also receive an automated call from us. We will do the following things:

• We will tell you Viva Medicare is calling you
• We will tell you the reason we are calling you
• We will provide you with a call back number

When you provide your phone number (cellular or landline) to us, you agree and consent for us to contact you at that phone number for certain health care calls (including voice messages made by an auto-dialer or a pre-recorded voice message). You may cancel (revoke or opt-out of) this consent by contacting our Member Services Department.

Viva Medicare will never ask you for your financial information on these calls. If you want us to contact you in a different way or you are not sure that the call you are receiving is legitimate, you should call Viva Medicare Member Services at 1-800-633-1542 or 205-918-2067 (Monday-Friday, 8am-8pm).

Complaints & Grievances

Getting Summary Complaint (Grievance) and Appeals Information

You can get summary information about the complaints (grievances) and appeals we have received. To request this summary information, please call (205-918-2067) fax (205-558-7414) or write Member Services (417 20th Street North, Suite 1100, Birmingham, AL 35203).

Filing a Complaint (Grievance) or Appeal to Viva Medicare

A complaint (grievance) does not involve a denied claim or a service request. You can file a complaint (grievance) if you have any type of problem with Viva Medicare, one of our network providers, or one of the companies who provide Viva Medicare benefits.

An appeal is how you ask Viva Medicare to review and change a decision we made about your coverage.

To make a complaint (grievance) or an appeal, please complete the Consumer Affairs form linked here and mail or fax the form to Viva Medicare (see contact information below). You can also call Member Services (see contact information below). For more information, please see Chapter 9 of your Evidence of Coverage for your plan above.

Mailing Address:

Viva Medicare
Attn: Medicare Member Appeals and Grievances Coordinator
417 20th Street North Suite 1100
Birmingham, AL 35203
Fax: 205-933-1239

Monthly Premiums

Members continue to pay the Part B premium to Medicare. Members who enrolled in a Medicare Part D prescription drug benefit after their initial eligibility period may have to pay a late enrollment penalty imposed by Medicare.

Plan Change

If you are a current Viva Medicare member and would like to change to one of our other Viva Medicare plans, complete the Plan Change form below and mail it to the address listed at the bottom of the form. Please be aware that you can change plans only at certain times during the year. Between October 15th and December 7th each year, anyone can change plans. Generally, you may not make changes at other times unless you meet certain special exceptions, such as if you qualify for a Medicaid program.

Ending Your Membership

While you are a member of our plan, you must continue to get your Medicare covered services through Viva Medicare.

• You should continue to use the Viva Medicare network of pharmacies to get your prescriptions filled (if you have prescription drug coverage through our plan).
• If you are hospitalized on the day your membership ends, your hospital stay will usually be covered by Viva Medicare until you are discharged.

Ending your Membership Voluntarily

You may voluntarily end your membership in Viva Medicare by submitting a written request during certain times of year, known as enrollment periods.

All members have the right to leave the plan during the Annual Enrollment Period (AEP) and during the annual Medicare Open Enrollment Period (OEP) by submitting a completed and signed disenrollment form or a written request. Please contact the plan for more information on how to submit a disenrollment request.

• AEP is from October 15th to December 7th.
  During this time, you can keep your current coverage with Viva Medicare or make changes to your coverage for the upcoming year. If you make a change during AEP, your coverage will end when your new plan’s coverage begins on January 1st.
• The OEP is from January 1st to March 31st.
  During this time, you can cancel your enrollment with Viva Medicare and make one change to a different plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan). Any changes you make will be effective the first of the month after the plan gets your request.

You generally cannot make other changes during the year unless you meet special exceptions (e.g., you have Medicaid or are eligible for Extra Help, etc.). Please refer to your Evidence of Coverage for more details about these exceptions.

Ending your Membership Involuntarily

We must end your membership in our plan if any of the following happen:

• If you do not stay continuously enrolled in Medicare Part A and Part B.
• If you move out of our service area.
• If you are away from our service area for more than 6 months.
• If you become incarcerated (go to prison).
• If you lie about or withhold information about other insurance you have that provides prescription drug coverage (if you have prescription drug coverage with our plan).
• If you intentionally give us incorrect information when you enrolled in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you do not pay the plan premium for 60 days (if you have a plan premium).
• If you have prescription drug coverage through our plan and are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.
• If you lose special needs status and do not reestablish special needs eligibility prior to the expiration of the period of deemed continued eligibility.
• If you pass away.
• If our Medicare contract and/or contract with the Alabama Medicaid Agency is terminated, or we reduce our service area to exclude the area you live in.
• If you are not lawfully present in the United States.

We cannot ask you to leave our plan for any reason related to your health. If we end your membership in our plan, we must tell you our reasons in writing. Viva Medicare must also explain how you can make a complaint about our decision to end your membership. Please refer to your Evidence of Coverage for information about how to make a complaint.