Save money with the mail order incentive programReceive a 90-day supply of select drugs mailed directly to your front door. There are no shipping and handling fees. Get a larger supply for a lower copay.

The mail order incentive program is offered in partnership with EnvisionMail. Using this program may reduce or eliminate your pharmacy visits.

Generally, the drugs we provide through mail order are drugs that you take on a regular basis, for a chronic or long term medical condition. Therefore, our mail-order service requires you to order a 90-day supply.

Once enrolled, you also have the option to sign up for the automatic refill program, to ensure you never run out of your medication. Under this program, EnvisionMail will start to process your next refill before you run out of your drug. The pharmacy will call to make sure you need the medication before shipping each refill.

Contact AgeWell New York Member Services if you have any questions about which of your medications may be covered. 1-866-586-8044.

AgeWell New York provides health care coverage that’s right for you. Our Medicare Advantage Plans are available to those with Medicare and those with both Medicare and Medicaid in the New York Metropolitan area including Westchester, Bronx, New York (Manhattan), Queens, Kings (Brooklyn), and Nassau counties.

We’re here for your call.Toll Free 1.866.586.8044 | TTY/TDD 1.800.662.1220agewellnewyork.com | info@agewellnewyork.com

Hours are 7 days a week from 8:00 am to 8:00 pm. Note: From April 1 to September 30, we may use alternate technologies on Weekends and Federal holidays.

PlanWell Mail Order Incentive ProgramConvenient, Dependableand Less Expensive.

WELLNESS DELIVERED TO YOUR DOOR

1.866.586.8044agewellnewyork.com

AgeWell New York, LLC is a Health Maintenance Organization (HMO) plan with a Medicare contract and a Coordination of Benefits Agreement with New York State Department of Health. Enrollment in AgeWell New York, LLC depends on contract renewal. This informa-tion is not a complete description of benefits. Call 1-866-586-8044 (TTY: 1-800-662-1220) for more information. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-866-586-8044 (TTY: 1-800-662-1220). ATENCIÓN: Si habla español, tiene a su disposición servicios gra-tuitos de asistencia lingüística. Llame al 1-866-586-8044 (TTY: 1-800-662-1220). Assistance services for other languages are also available free of charge at the number above. H4922 _PWMO4041_M Accepted 03222019

BenefitsWellness

> Helps you to keep on track with your doctor’s treatment plan.

> Lessen the stress of managing refill schedules.

Convenience > Delivery to your home or location of your

choice. > Eliminate extra trips to the pharmacy. > Refills are easy - you will get a call to

authorize all refills.

Affordable > No shipping and handling fees. > Larger supply for lesser copay.

Costs and EnrollingThe cost of your maintenance drug depends on the Formulary Tier in which it falls and if you receive Low Income Subsidy. Review the table below for cost information.

PlanWellCost Sharing Tier A Participating Pharmacy

(90-day supply)Mail Order Cost Sharing (90-day supply

Tier 1 (Preferred Generic) $0.00 $0.00Tier 2 (Generic) $25.00 $15.00Tier 3 (Preferred Brand) $129.95 $117.50Tier 4 (Non-Preferred Brand) $275.00 $250.00Tier 5 (Specialty) 28% of the cost of the drug 28% of the cost of the drug

* Cost reflected are for drugs filled while in the Initial Coverage Stage. Part D deductibles must be met for Tier 3, Tier 4 and Tier 5 drugs. Cost will differ in the Coverage Gap Stage and the Catastrophic Coverage Stage. Please refer to your plan’s Explanation of Coverage for more information.

Enroll Today REGISTER ONLINE1.) Go to envisionpharmacies.com 2.) Click register now 3.) Create your member profileOnce registered you can: • Select your shipping preferences • Add a credit card to your account • Change your personal information • Order and track refills in your account

• View your order history

REGISTER BY PHONEEnroll via telephone at 866-909-5170 or TTY 711 (Monday – Friday 8:00 a.m. – 10:00 p.m., and Saturday 8:30 a.m. – 4:30 p.m.)

REGISTER BY MAILComplete enrollment form and mail to EnvisionMail at: 7835 Freedom Ave NW, North Canton, OH 44720

E-PRESCRIPTIONSHave your physician electronically prescribe (e-prescribe) your refills via the internet. Call or fax your next 90-day prescription: Call Center: 1-866-909-5170 | TTY- 711 | Fax: 1-866-909-5171

If you have any questions about the mail order incentive program please call AgeWell New York at 1-866-586-8044 or TTY 1-800-662-1220 from 8:00 a.m. to 8:00 p.m. 7 days a week. You can also visit us online at www.agewellnewyork.com. If you would prefer this information in different languages, please call our Member Services Department.