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MetroPlus Platinum Plan (HMO)

To be eligible for MetroPlus Platinum Plan (HMO), you must be eligible for Medicare Parts A and B; reside in Manhattan, Brooklyn, Queens or the Bronx; and not have End-Stage Renal Disease (ESRD).

In 2010, MetroPlus Platinum Plan (HMO) provides all the benefits of Original Medicare PLUS:

• $0 monthly plan premium in addition to your monthly Medicare Part B premium
• $0 copayment for Primary Care visits
Prescription Drug coverage
• Dental - $0 copayment for preventive exam
• Vision - $0 copayment for eyeglasses or contact lenses
• Hearing Aids - $0 copayment for hearing aids
• Transportation - Up to 6 round trips to any plan-approved location every year using
   New York City MTA Subway and Bus Service

2010 Summary of Benefits English Spanish

2010 Evidence of Coverage English Spanish

MetroPlus Medicare Provider and Pharmacy Directory

Check to see if you qualify for MetroPlus Medicare Plans

How to enroll

You can meet with a MetroPlus Medicare representative at these locations, email MetroPlus or complete the MetroPlus Medicare Enrollment Request Form English or Spanish and send it to:

MetroPlus Health Plan
Attn: MetroPlus Medicare Customer Services
160 Water Street, 3rd Floor
New York, NY 10038

Medicare Customer Services: 866-986-0356, TTY 800-881-2812
Customer Services Hours: Monday - Saturday, 8 am - 8 pm
November 15 - March 1 only, Monday - Sunday, 8 am - 8 pm

H0423_MKT0908v2_10/2009
10/30/2009



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