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Valor Health Plan HMO Special Needs Plan with Prescription Drug for Institutional Residents (2021)

Valor Health Plan (HMO-SNP) is a Medicare Advantage health plan designed specifically for Medicare beneficiaries that reside in a long-term care facility. Valor Health Plan is headquartered in Northeast Ohio and available in select Ohio CMS-approved counties.

The Valor Advantage

  • Low Cost Premium $29.80 deductible for medical coverage
  • Physical, Occupational and Speech Therapy No annual limit
  • Skilled Nursing Care No prior hospital stay requirement
  • All-In-One Plan Covers original Medicare benefits plus Medicare Part D prescription drugs
  • Over-the-Counter OTC Benefit $150 per quarter OTC benefit
  • Local Care Team Hands-on RNs and Nurse Practitioners to assist with quality care coordination

Summary of Important Costs
Monthly Premium $29.80
Primary Care Visit 20% per visit
Specialist Visit 20% per visit
Inpatient Hospital Stays $1,408 deductible for days 1 – 60
$352 copay per day for days 61 ? 90
$704 copay per lifetime reserve day
Part D Prescription Drugs Standard Benefit Coinsurance during the Initial Coverage Stage: 25%

Last Updated: Oct 21, 2020 @ 4:13 pm

Enrollment Process

Enroll in a Medicare Advantage Special Needs Plan that’s right for you. Our dedicated licensed agents are here to guide you through the enrollment process. Simply call 1-800-485-3793 and set up an appointment to begin the enrollment process.

Valor Health Plan also accepts enrollment forms by fax, mail or through the Centers for Medicare & Medicaid (CMS) Medicare Online Enrollment Center located at www.medicare.gov.

Once we confirm your eligibility with Medicare, you can expect to receive a confirmation letter by mail, identification card and your new member mailing within 10 days.

Call our Call Center (available 8am – 8pm) at 1-800-485-3793.

Click the link below to download the enrollment form.

Download Enrollment Form

Last Updated: Oct 21, 2020 @ 4:15 pm


Disenrollment Process

Medicare Advantage Ending My Membership (Disenrollment)

Disenrollment means ending your membership with Valor Health Plan.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you must ask to be disenrolled from our plan.

If you have any questions about how or when to disenroll, please contact us to guide you through the disenrollment process. You may also find helpful information in the Evidence of Coverage document, Chapter 10, ?Ending your membership in the plan.?

Last Updated: Sep 2, 2020 @ 10:42 am

Formulary

Online Prior Authorization
Comprehensive FormularyLast updated 10/2020
Step Therapy CriteriaLast updated 10/2020
Quantity LimitLast updated 10/2020
Pharmacy Prior AuthorizationLast updated 10/2020
Formulary ChangesLast Updated 10/2020
Redetermination Request Form
Coverage Determination Request Form
Online Formulary Search Tool

Other Resources

Pharmacy Search
Medication Transition Policy
Medication Therapy Management

This section last modified: Oct 12, 2020 @ 9:57 am

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