Plan Information

Viva Medicare has all-in-one plans that let you Enjoy Life without the worry. You might even save some money while you're at it.

Additional Plan Information

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Viva Medicare Formularies

Formularies (lists of covered drugs) offer members access to both generic and brand name drugs. The formulary includes prescription drugs in every therapeutic class and category. Please review the information in the formulary introduction to learn more about the Viva Medicare Rx drug benefit – including how to ask for an exception if your drug is not on the formulary, has a coverage restriction, or is covered as a non-preferred drug.

NOTE: Look up your medication in the index in the back. Then go to that page number to see the drug's tier. The amount you pay for drugs depends on which Viva Medicare plan you are on. Copays are listed in the front of your formulary.

The formulary may change during the year. Members can find information regarding any mid-year non-maintenance formulary changes to the printed formulary, as well as Prior Authorization and Step Therapy criteria, by looking below or calling Member Services. You can also review your monthly Part D Explanation of Benefits (EOB) to see which of the drugs you are currently taking are coming off the Viva Medicare formulary.

* What plan am I on? Click Here

Pharmacy Directories

For plans that include prescription drugs, this booklet provides a list of Viva Medicare network pharmacies and includes some basic information about how to fill your prescriptions.

Provider Network

When you join Viva Medicare you choose one doctor to be your Personal Care Physician (PCP).

You will use the specialists and hospital associated with your PCP when you need medical care. This is called your Provider System.

The Viva Medicare Provider Systems are listed below. Click on a Provider System to see a list of doctors and hospitals who are in that provider system. You may also use the "Provider Search" feature below to search by a doctor's last name or specialty.

Newsletters

View past and present issues of Enjoy Life by clicking the images below. In these newsletters you can learn:

• How to get the most value out of your member benefits
• Health and Wellness Tips
• Healthy Cooking Recipes
• Free Viva Medicare Member Events in Your Community
• and much more!

Winter 2019

All Other Plans - Fall 2018

Extra Value - Fall 2018

Summer 2018

Spring 2018

Medication Therapy Management Program

Medication Therapy Management (MTM) is a patient-centered and comprehensive approach to help members understand their medications and use them safely.

The Medication Therapy Management (MTM) Program is not a covered benefit of Viva medicare. Rather, it is a program available, at no additional cost, to members who meet certain criteria. You will be automatically enrolled in the Medication Therapy Management Program if you meet ALL of the following three (3) criteria:

The viva medicare MTM Program offers a Comprehensive Medication Review (CMR) for all eligible members either face-to-face or over the phone. Members who meet eligibility requirements will be automatically enrolled and sent an invitation letter welcoming them to the program. After receiving the invitation letter, you will be contacted by a partnering local pharmacy, an MTM call center, or a Viva Medicare pharmacist or other qualified provider to schedule your medication review. A CMR takes about 30 minutes and is usually offered once each year. A specially trained pharmacist or other qualified provider will review your medication history, including prescription and over-the-counter medications, and identify and resolve any medication issues. Confirmed medication-related problems and recommendations may be communicated to your prescriber. Upon completion of the CMR, you will be mailed a Medication Action Plan that provides steps you should take to help you get the best results from your medications, and a Personal Medication List that will help you keep track of your medications and how to use them the right way. You may obtain a blank copy of the Personal Medication List by clicking here.

You may choose to disenroll from the MTM Program any time during the year or you may decline individual services without having to disenroll from the program. In addition to the CMR, all MTM eligible members will also receive a Targeted Medication Review (TMR). The pharmacy claims of all members who qualify for MTM will be reviewed every three months to identify any new or persistent drug therapy problems, such as the presence of potential safety problems and/or gaps in care involving adherence to chronic medications and omissions in care. If the TMR analysis identifies any issues, then follow-up intervention opportunities are communicated to your prescriber(s) via fax or mail.

For more information on Viva health Medicare MTM Program, please contact our member services department at 1-800-633-1542 or 205-918-2067, TTY users call 711. Hours are Monday-Friday, 8 a.m.-8 p.m. From October 1st-March 31st, seven days a week, 8 a.m.-8 p.m.

Viva Medicare 2019 Advantage Plan Service Area

Select a Viva Medicare Plan and find out what counties they are offered in

All Medicare Coverages

The Viva Medicare Me plan is only available in Blount, Chilton, Jefferson, Shelby, St. Clair, Talladega, and Walker counties.

Not all Viva Medicare plans are offered in all counties in our service area. The county you live in will determine which plans are available to you.

Member Portal

The Viva Member Portal is your 24/7 secure member website for managing your account, accessing prior claims, requesting a replacement member card, and more. Access is free, easy, and secure!

Contact Us

Member Calendar

Viva Medicare Event Calendar

Stay Up-To-Date!

The Viva Medicare Calendar keeps you up-to-date on fun & free events, lists our Café locations, highlights special healthcare related months, includes preventative care opportunities, and much more…

Asking for a Coverage Decision for Medical Care/Services

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).

To find out information about the Medicare Ombudsman click here.

Asking for a Coverage Decision (Coverage Determination & Exception) for Part D Prescription Drugs

Whenever you ask for a Part D prescription drug benefit, the first step is called requesting a coverage determination.

If your doctor or pharmacist tells you that a certain prescription drug is not covered, you must contact Member Services if you want to request a coverage determination. When we make a coverage determination, we are making a decision whether or not to provide or pay for a Part D drug and what your share of the cost is for the drug. You have the right to ask us for an "exception," which is a type of coverage determination, if you believe you need a drug that is not on our list of covered drugs (formulary), or you believe you should not have to meet prior authorization or other utilization management requirements, or you believe you should get a non-preferred drug at the lower preferred drug copayment. If you request an exception, your physician must provide a statement to support your request.

Viva Medicare's coverage determination and exception request form is included below. You may also submit your request via the Online Request for Medicare Prescription Drug Coverage form. If we deny your request, we will send you a written decision explaining the reason why your request was denied. We may decide completely or only partly against you. For example, if we deny your request for payment for a Part D drug that you have already received, we may say that we will pay nothing or only part of the amount you requested. If a coverage determination does not give you all that you requested, you have the right to appeal the decision.

You can also request a coverage determination by writing to Viva Medicare, Attention: Pharmacy, 417 20th Street North, Suite 1100, Birmingham, AL 35203 or you can fax your request to us at 205-558-7414.

You can request an expedited coverage determination by calling 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 contact the numbers above for process or status questions.

To find out information about the Medicare Ombudsman click here.

Filing a Complaint to Medicare

You have the right to contact Medicare and file a complaint about your coverage decision. You may contact Medicare to file your complaint by clicking here and by following the instructions on the form.