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Medica Disaster Planning Policy

For Medica Medicare Members

Getting Care During a Disaster

If the State Governor, the U.S. Secretary of Health and Human Services, CMS (the Centers for Medicare & Medicaid Services), or the President of the United States declares a disaster or emergency in your geographic area, Medica will ensure you receive the services you are entitled to from your plan.

During a declared state of disaster or emergency, if you need care and you can’t make it to a Medica network facility, medical office, or pharmacy:

• Medica will cover medically necessary plan benefits furnished to you by out of network providers and pharmacies
• You do not need to get a referral or prior authorization to go outside the network.
• You will be responsible to pay only your in network cost share for these services.
• You will be able to receive Part D drugs prior to the refill date if appropriate.
• You can obtain the maximum extended day supply of Part D drugs; if available at time of refill.

When the Disaster Ends

Once the State Governor, the U.S. Secretary of Health and Human Services, CMS (the Centers for Medicare & Medicaid Services), or the President of the United States declares the disaster or emergency is over, or after 30 days have passed when there is no end date declared, you will need to use the plan provider network to receive services and the normal pre-authorization/referral requirements and cost sharing will resume as described in your Evidence of Coverage.

If Medica cannot resume normal operations, we will notify CMS (the Centers for Medicare & Medicaid Services).