National Coverage Determination (NCD)
The Centers for Medicare & Medicaid Services (CMS) sometimes change the coverage rules that apply to an item or service under Medicare. Such changes may include what benefits and services are covered, what benefits and services are changing, and what Medicare will pay for an item or service. When this happens, CMS issues a National Coverage Determination, or NCD.
||Transcatheter Aortic Valve Replacement (TAVR)
||Acupuncture for Chronic Lower Back Pain (cLBP)
||Ambulatory Blood Pressure Monitoring
||Next Generation Sequencing (NGS)
||Implantable Automatic Defibrillators
||Supervised Exercise Therapy (SET) FOR Symptomatic Peripheral Artery Disease
||Screening for Hepatitis B Virus (HBV) Infection
Click here to access the CMS annual database where all NCDs are posted by year.
*By clicking the links above you may be directed away from www.vivahealth.com.
In 2017 and 2018, the Viva Medicare Select plan has a $0.00 monthly plan premium (members continue to pay the Part B premium to Medicare).2
2 You must continue to pay your Part B premium.
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 get Extra Help for prescription drugs or qualify for a Medicaid program.
Getting Help from 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 8:00 am - 8:00 pm, Monday through Friday. Extended office hours (Oct. 1 - Mar. 31) are from 8:00 am - 8:00 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. For more information regarding these processes, see the information below.
Asking for a Coverage Decision
A coverage decision is a decision we make about your benefits and coverage. You or your doctor can contact us and ask for a coverage decision. You can also ask us for a coverage decision if your doctor refuses to provide/arrange medical care you think you need. To ask for a coverage decision, please call, fax or write Member Services and we will give you an answer in a timely manner (see contact information above).
Filing a Complaint or Grievance
A complaint (grievance) does not involve a coverage decision. You can file a complaint (grievance) if you have any type of problem with Viva Medicare or one of our network providers. To make a complaint (grievance), please call Member Services (see contact information above). You can also complete the Consumer Affairs form listed below and mail or fax the form to Member Services (see contact information above). Please see Chapter 9 of your 2017 and 2018 Evidence of Coverage for more information.
Filing an Appeal
If you are not satisfied with a coverage decision we have made, you can file an appeal. An appeal is a formal way of asking us to re-review and change a coverage decision we have made. To file an appeal, please call Member Services (see contact information above). You can also complete the appropriate form listed below and mail or fax the form to Member Services (see contact information above). Please see Chapter 9 of your 2017 Evidence of Coverage for more information.
Appointing a Representative
You can name (appoint) someone to file a complaint (grievance) or appeal for you. This person you name would be your representative. To appoint a representative, complete the appropriate form below and mail or fax it to Member Services (see contact information above).
ADDITIONAL PROGRAM BENEFITS
CMS Appointment of Representative Form for Appeals (Form CMS-1696)
*By clicking the links above you may be directed away from www.vivahealth.com.
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, fax or write Member Services (see contact information above).
Ending your Membership Voluntarily
You may voluntarily end your membership in Viva Medicare only 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)
- AEP is from October 15th – December 7th
- During this time of year 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 then your coverage will end when your new plan’s coverage begins on January 1st.
- The OEP is from January 1st – 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) once during this time. 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.
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.
Until your Membership Ends, You Must Continue to Get Medicare Covered Services Through Our Plan
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.
How to Get More Information
If you need assistance or more information on regarding ending your membership, call Member Services at 1-800-633-1542. We are available from 8 a.m. to 8 p.m., Monday through Friday (from October 1 to March 31, available 8 a.m. to 8 p.m., 7 days a week). TTY users call 711. You can also refer to the “Medicare and You” handbook you receive each fall or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 711.