Network PlatinumPremier | Network Health Insurance Corporation

Network PlatinumPremier

The Network PlatinumPremier Plan offers richer benefits and discounts with little to no out-of-pocket costs. You’ll enjoy a $0 co-pay for in-network hospital stays, skilled nursing care, outpatient services, doctor and specialist visits, and more. You’ll even receive in-network benefits when you travel out of state. Additionally, there are NO out-of-pocket expenses for Medicare-covered services when receiving care from in-network providers. If you choose to see out-of-network providers for Medicare-covered services, the maximum you will pay out-of-pocket will be $1,000 annually, excluding prescription drug costs.

For more information on the benefits of the Network PlatinumPremier Plan, read the explanations below or check out the 2010 Summary of Benefits for details and coverage comparison charts.

Is My Drug Covered?

Find out if your drug is coverered in our drug formulary:

Search the Formulary Directory

Find out if your local pharmacy is in the network:

Search for my Local Pharmacy

Is My Doctor in the Network?

Use our search tool to find health care providers and facilities in our network.

Search the Provider Directory

Grievance and Appeals

Read more about exception and appeals information for:

Evidence of Coverage

View a complete list of benefits for each plan by selecting the corresponding document below:

Network Health Plan
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Last Updated: 9/1/2010

© Affinity Health System. All rights reserved.

Network PlatinumPlus, Network PlatinumPremier and Network PlatinumSelect are Medicare Advantage Preferred Provider Organization (PPO) plans offered by Network Health Insurance Corporation, a Medicare Advantage organization that contracts with the federal government. Network Health Insurance Corporation's contract with the Centers for Medicare and Medicaid Services is renewed annually. Availability of coverage beyond the 2010 contract year is not guaranteed.

Network Health Insurance Corporation (NHIC) contracts with a network of providers within the 13 county service area to provide Medicare covered benefits. Our Network Medicare Advantage plans are open to all Medicare beneficiaries eligible by age or disability in the plans' service area. With the exception of emergent care which is covered at the in-network level cost share, members are allowed to use non-plan providers outside of the contracted network but it may cost more to do so. Our Network Medicare Platinum Plans provide reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.

To qualify, you must be entitled to Medicare Part A, be enrolled in Part B, be a resident of the service area and not have End-Stage Renal Disease (ESRD). Members must continue to pay Medicare Part A, if applicable, and Part B premiums. If you enroll in one of our Medicare Advantage Plans, you must receive your Medicare prescription drug benefit through the plan. Our Network Medicare Advantage Pharmacy Plans use a formulary, which is a list of preferred drugs covered by the plan. People with limited income and resources may qualify for extra help from the government, pay a lower premium and pay less at the pharmacy.

If you prefer us to send you information in a language other than English, please contact Customer service at 1-800-378-5234 or TTY 1-800-947-3529.

We also offer NetworkCares, a $0-premium full dual-eligible Special Needs plan for people with Wisconsin Medicaid who also have (or will soon be eligible for) Medicare. Please contact us at 1-800-983-7587 or TTY 1-800-947-3529 if you'd like more information about this Special Needs Plan.

A partnership of Ministry Health Care and Wheaton Franciscan Healthcare.