2026 Plan Documents and Information

Plan Documents and Directories

Annual Notice of Change
Evidence of Coverage
Summary of Benefits
Provider Directory
Pharmacy Directory
Formulary

Medical Plan Information

Expedited Determinations
Medicare Part C Transition Policy
Aggregate Number of Prior Authorizations, Appeals, and Grievances
Appeals for Medical Benefit (Healthcare Services or Part B Drugs)
Part B Step Therapy
Complaints and Grievances
Medicare Ombudsman

Prescription Drug Information

Prior Authorization
Coverage Determinations and Appeals for Part D Drug
Medicare Prescription Payment Plan
Medication Adherence
Medicare Part D Drug Transition Policy
Quality Assurance
Medicare Part D Utilization Management
Pharmaceutical Assistance Programs
Prescription Mail-order Services
Out-of-network Pharmacy Coverage and Prescription Drug Claim Form
Medication Therapy Management
Drug Management Program
Part D Forms

Other Plan Information

Appointment of Representative
Getting Care During a Disaster
Best Available Evidence
Disenrollment Information
Payment Information

Plan Documents and Directories

Annual Notice of Change

Evidence of Coverage

Summary of Benefits

Provider Directory

Pharmacy Directory

Members have access to network pharmacies for their prescription drug benefits. Pharmacies located near you can be found in our Pharmacy Directory. Pharmacy network listings may change throughout the year. However, you can always find the most current pharmacy listing online by using our Find a Pharmacy tool.

Online Pharmacy Locator

2026 Paramount Elite Pharmacy Directory

Note: Our pharmacy network is subject to change at any time; however, you will receive notice before any network changes.

Formulary

If your plan Medicare Plan includes prescription drug coverage, make sure you look for your medications on our prescription drug list (formulary). For a complete prescription drug list, download a copy of our formulary:

Medicare Part D Comprehensive Formulary: Enhanced, Preferred, Prime and Standard Plans

Medical Plan Information

Expedited Determinations

An expedited determination (fast coverage decision) can be requested for healthcare services or Part B drugs (called an “organization determination”) or for Part D prescription drugs (called a “coverage determination”). You can ask for an expedited determination if you meet these two requirements:

You are asking for an expedited determination (fast coverage decision) for healthcare services, Part B drugs or Part D drugs that you have not yet received.
Your provider tells Paramount that if we take the standard 14 days to make a decision, it could cause serious harm to either your health or your ability to function. Please note that if your provider requests an expedited determination (a fast coverage decision), the request will be expedited automatically.

Expedited Organization Determinations - Part B Drugs

When you make a request for coverage for healthcare services or Part B drugs, this is called an “organization determination.” Paramount will make a decision for your organization determination as quickly as your health condition requires – but no later than 72 hours after receiving a valid request.

You (or your appointed representative) and your requesting provider will be notified of the decision whether approved or denied. Paramount will call you (or your appointed representative) and your requesting provider with the coverage decision, and a letter will be mailed within three (3) calendar days of the telephone call. If the request was denied, the denial letter will explain why the coverage request was denied and it will list your rights and instructions if you wish to file an appeal (also called a reconsideration).

How to Request an Expedited Organization Determination - Part B Drugs

If your health condition requires a fast coverage decision, it would be best to have your provider send us a request for an expedited organization determination (fast coverage request) so that we have the medical information that we need to make a decision as quickly as possible. Please complete any of the following to ask for an Expedited Organization Determination:

Fax a prior authorization request to Paramount’s Utilization Management team at 419-887-2028
Call Paramount’s Utilization Management team at 419-887-2520, or toll-free 800-891-2520
Complete the Member Organization Determination form

In the event that a fast coverage request (expedited organization determination) does not meet the criteria for expedited handling, Paramount will automatically transfer and process the request as a standard organization determination (non-urgent coverage request) using the 14-calendar day timeframe, which applies for standard organization determinations.

If Paramount transfers your fast coverage request (expedited organization determination) to the standard processing timeframe, you will be notified by phone and a letter will be mailed to you with an explanation of why your fast coverage request did not meet the criteria for expedited handling. You have the right to file an expedited grievance with Member Services if you disagree with the decision not to expedite the request.

Expedited Organization Determinations - Healthcare/Medical Services

Paramount will make a determination as quickly as your health condition requires – but no later than 72 hours after receiving the request.

You and your requesting provider will be notified of the decision, whether favorable or adverse. Paramount will notify you and your requesting provider of an adverse decision orally, followed by written confirmation mailed to you within three calendar days of the telephone call. The written notice will explain why the request was denied and your rights to file a reconsideration or an appeal.

How to Request an Organization Determination - Healthcare/Medical Services

To initiate an organization determination, have your provider complete any of the following:

Fax a prior authorization request to Paramount’s utilization management team at 419-887-2028.
Providers may also submit high-dollar imaging procedures through the web-based prior authorization submission tool McKesson Clear Coverage.
Complete the Member Organization Determination form and fax to 419-887-2047

If Your Request to Expedite is Denied

If your request is denied, we’ll call you. Then, within three calendar days, you’ll receive a letter. The letter explains the enrollee’s rights:

Paramount will automatically transfer and process your request using the 14-day timeframe for standard determinations. For Part B drugs, Paramount will use the 72-hour timeframe.
You have the right to file an expedited grievance if you disagree with the decision not to expedite the determination.
You can resubmit a request for an expedited determination. If your provider indicates that the 14-day timeframe could seriously jeopardize your life or health or your ability to regain maximum function, the request will be expedited automatically.
The letter will provide instructions about the expedited grievance process and its timeframes.

Medicare Part C Transition Policy

Beginning Jan. 1, 2026, if you are a new member of your Medicare Advantage plan (Paramount Elite) and/or to Medicare and are currently undergoing an active course of treatment, you may qualify for a transition period for Medicare Part C covered drugs and services. For some drugs and services, we require additional information from your provider to determine if the drug or service is medically necessary.

We will cover restricted Medicare Part C drugs or services for the first 90 days of your Medicare Advantage plan (Paramount Elite) to ensure you do not experience any disruptions. We will work with your provider to get all the information needed to determine if we will continue coverage.

For more information regarding our Medicare Part C Transition Process, please call Member Services toll free at 1-833-554-2335 (TTY: 711 for hearing impaired).

Your provider can start a determination (also known as an organization determination) by contacting the following organizations:

For Part B drugs, have your provider submit a request to Prime Therapeutics
For Part C outpatient medical services or items, your provider should fax in the request utilizing one of Paramount prior authorization forms.

For Medicare Part D Transition policy, call our Pharmacy Customer Service team at 1-833-554-2335 (TTY 711), 24 hours a day, 7 days a week.

Aggregate Number of Prior Authorizations, Appeals, and Grievances

As a Medicare Advantage plan, Paramount tracks information related to member appeals and grievances (complaints) processed. Anyone who is eligible to enroll in a Medicare Advantage plan has the right to ask for information about the number of appeals and grievances that a Medicare Advantage plan receives. This information is provided upon request and lists the average number of appeals and grievances received per 1,000 members (example: 1 grievance per 1,000 members) during the most recent reporting period, which is based on the calendar year (not based on the last 12 months). Please contact Member Services and let the representative know that you would like to receive an Appeals and Grievances Data Report for the Paramount Medicare Advantage plans that are offered in your service area. (Ref: Per 42 CFR 422.111(c)(3)).

Appeals for Medical Benefit (Healthcare Services or Part B Drugs)

When to Request an Appeal for Your Medical Benefits (Healthcare Services, Medical Items, or Part B Drugs)

An appeal (or “reconsideration”) is something that you have a right to ask for either after you receive:

a denial notice (which is issued before you receive the services/item/Part B drug)
or
an Explanation of Benefits (also called an “EOB”), which is only issued after a claim was processed. The EOB lists your official plan coverage for specific healthcare services.
The term “healthcare services” includes health-related services, medically necessary equipment and items, and Part B drugs but does not include Part D (prescription) drugs.

When Paramount calls you or sends you a notification letter, or issues an EOB, to let you know of its decision to either cover or deny your healthcare services, that first decision is called an “organization determination.”

If you disagree with any organization determination (coverage decision) made by Paramount because you believe that the healthcare service(s) should be covered or that the amount of coverage listed in your EOB is not correct, please consult your Evidence of Coverage (EOC) first.

Standard Appeal Process

If you still disagree with any coverage denial notice and you are waiting to receive any healthcare service, you (or your treating provider) should request an appeal. An Expedited Appeal is available if your medical condition or healthcare status requires a fast decision.

Please know that you may go to any provider when emergency medical care is medically necessary. Coverage details for emergency healthcare are contained in your plan’s EOC.

If you are waiting to receive any healthcare service and the first request for a coverage decision (organization determination) was denied, we suggest that you ask your treating provider to submit the appeal on your behalf. You (or your provider) may also file an appeal if you receive a notice that certain healthcare services that you have already been getting will be reduced or stop being covered.

You have a right to ask for an appeal any time you disagree with a coverage decision (organization determination). You do not need to know which type of appeal to request because we will use the information on file to figure out which appeal type is appropriate when your appeal request is received.

While you always have a right to contact Member Services and request your own pre-service appeal (reconsideration), your treating provider can provide important medical information and/or records more quickly and securely when medical information is needed to support the appeal request. Also, if your health condition or status requires a faster response while you are waiting to receive any healthcare service(s), your treating provider can provide important medical details that will allow Paramount to make its decision faster. Please see the section related to Expedited Appeals to understand the timeframe allowed for making an Expedited Appeal decision.

Please Note: If Paramount has not yet made its decision regarding coverage of any specific healthcare service(s) requested, then an appeal is not available because you (or your provider) can only ask for an appeal after a coverage decision is made. You will know that a coverage decision was made after healthcare services were received because you will receive an EOB (after a claim was processed). Again, you cannot request an appeal until a coverage decision (organization determination) has been made.

Paramount must receive a valid request to appeal no later than 65 calendar days from the date noted on your organization determination (coverage decision) notice in order to guarantee a review of your request. Any appeal request received after this timeframe is not guaranteed to be accepted and may be dismissed as invalid.

Expedited Appeal Process

Asking for a fast appeal (expedited reconsideration) means that you (or your appointed representative) or your provider is asking Paramount to make its appeal decision within 72 hours of your fast appeal (expedited reconsideration) request. You (or your appointed representative) or your provider can ask for a fast appeal (expedited reconsideration) for healthcare services (including medical items or Part B drugs), if these two requirements are met:

The fast appeal (expedited reconsideration) is requesting coverage of healthcare services (or medical items or a Part B drug) that you have not yet received.
If we were to use the standard timeframe deadline to process your appeal (which is 30 days for healthcare services and medical items OR 7 days for Part B drugs), those additional days could result in serious harm to your health or hurt your ability to function.

This means that you cannot request a fast appeal (expedited reconsideration) regarding payment for any healthcare service, medical item, or Part B drug you have already received.

Sometimes Paramount needs to ask for more information from your provider, so this could delay our decision. If your fast appeal (expedited reconsideration) request is for healthcare services or medically necessary items and we think that your provider may provide us with additional important information to support the expedited appeal request, then Paramount may extend the decision deadline by 14 more days. Please note that Paramount cannot extend the deadline for a fast appeal (expedited reconsideration) decision related to Part B drugs.

If Paramount extends the deadline for making a fast appeal (expedited reconsideration) decision related to coverage for healthcare services or medically necessary items (but not Part B drugs), or if Paramount changes the status of an Expedited Appeal request to a Standard Appeal, we will call you first to let you know, and then a letter will be mailed to you to explain the reason for the extension or the change in priority status and why we think the extension is in your best interest. You have the right to file an expedited grievance with Member Services if you disagree with our decision either to change the status of an appeal request from Expedited to Standard or because we extended the deadline for making our decision regarding your fast appeal (expedited reconsideration).

Payment Appeal Process (does not apply to Standard or Expedited Appeals)

When a valid Payment Appeal request is received by Paramount, the appeal decision is required to be made no later than the applicable timeframe listed below:

60 calendar days for claims payments already processed and related to healthcare items or services already provided (including Part B drug payments)

If you received an EOB and you disagree with the coverage amounts (or denials) listed, compare the information in your EOB to your Evidence of Coverage (EOC). If you still disagree with Paramount’s organization determination (coverage decision) after comparing the EOB to your EOC, please contact Paramount’s Member Services team and request an explanation of why the healthcare service(s) will not be or was/were not covered.

If you still disagree with a coverage decision described in your EOB (after a claim has processed), you should request a Payment Appeal. These appeals cannot be expedited.

How To Make an Appeal Request for Your Medical Benefits (Healthcare Services, Medical Items, or Part B Drugs)

Your organization determination notice is a document that Paramount sent to you to let you know its decision regarding a coverage request. This notice will either be a coverage decision (usually a Notice of Denial) letter or an Explanation of Benefits (EOB), depending on whether or not a claim has already been processed. You must use one of the following methods to request an appeal with Paramount for healthcare services (including medical equipment/items or Part B drug) decisions:

Call 833-554-2335 to talk with a Member Services representative. Member Services Representatives are available Monday – Friday, 8 a.m. – 8 p.m. from April 1 through September 30 (closed Memorial Day, Independence Day and Labor Day). From October 1 through March 31 (closed on Thanksgiving and Christmas), Member Services is open 8 a.m. – 8 p.m., seven (7) days a week. If you use TTY telephone equipment, please call 711. Free interpreter services are available.
Fax your written appeal request letter or form to 419-887-2037 Attention: Appeals Coordinator, Member Services Department
Mail your written appeal request to:
Paramount
Attn: Appeals Coordinator, Member Services Dept.
P.O. Box 928
Toledo, OH 43697-0928

You do not need to know which type of appeal request is needed

If you call Member Services to ask for assistance regarding how to file your appeal request, our Member Services representatives will review the details of your appeal request with you (or your representative) and give you instructions on how to submit it. You may file your Standard appeal request by mail or fax, or you can have your treating provider submit an appeal on your behalf if you have not yet received the healthcare service (or medical item or Part B drug). We cannot accept any appeal request received via Live Chat, and we do not encourage you to submit your appeal request via email because email is not secure.

If any appeal request received is not valid, we will send you a written notice advising what is needed for us to accept your appeal request as valid.

If any appeal request is received and the person who filed the appeal is not properly appointed or authorized to file the appeal request for you, we will try to contact you to obtain valid documentation of representation. If we do not receive valid documentation to make your appeal request valid before the deadline (see the timeframes listed on this page), we will send you a Notice of Appeal Dismissal.

Please note that if a valid appeal request is received after the appeal filing deadline, which is 65 calendar days after the date of your written notice that included appeal rights, and you did not explain valid reasons for filing your appeal request after the 65 day deadline, you will receive a Notice of Appeal Dismissal.

If your doctor or other treating physician tells us that your health condition requires a “fast decision” for a valid appeal request, we will automatically use the Expedited Appeal timeframe.

Refer to your plan's Evidence of Coverage for complete appeal guidelines for your plan.

You Can Ask Someone Else to Act on Your Behalf for Appeals

If you would like to name another person to act as your representative so that this person can contact Paramount and make appeal requests for you, you can complete and send us an Appointment of Representative (AOR) form or send us a letter that contains the same information as the AOR form and your signature.

You do not need to appoint a representative to file any appeal on your behalf, unless you want to. If you wish to appoint a representative for the purpose of filing an appeal (or grievance) on your behalf, this requires either a valid AOR or Power of Attorney (POA) to be on file in your record with our plan and may be submitted with the appeal request.

You do not need to appoint your treating physician to appeal on your behalf for a pre-service appeal, however, you can if you choose to. This appointment requires a valid AOR.

You can appoint a non-contracted provider to file an appeal on your behalf, however, this is not required because a non-contracted provider is required to submit different documentation to file an appeal on your behalf.

What Happens After We Make an Appeal Decision

If your appeal request is either denied, or if the appeal decision timeframe is not met (including any extension taken), Paramount must forward your appeal request to an independent review entity (IRE) within 24 hours of either the decision to deny your appeal request or the missed appeal decision deadline, whichever comes first. When your appeal request is transferred to the IRE, this is called a “second level appeal.” These rules apply to Standard, Expedited, and Payment appeal requests regardless of whether the appeal request is for Part B drugs, or healthcare items or services.

If your appeal request is forwarded to an IRE (for a second level appeal), you will receive written notification from the IRE that describes your second level appeal request and the required deadline for the IRE to make its decision. The IRE will then issue its second level appeal decision within the allowed timeframe for your type of appeal request and will send you written notification of its decision, including any additional appeal rights that are available to you. If you have not received timely written notification of a decision for any appeal request within 5 days after the appeal decision deadline for your appeal request has passed, please contact Member Services for assistance. Again, you may view your plan's Evidence of Coverage for a complete description of the appeals process.

Part B Step Therapy

Some medically administered Part B drugs may have additional requirements or limits on coverage. These requirements and limits may include step therapy, where Paramount requires you to first try certain preferred drugs to treat your medical condition before covering another non-preferred drug for that condition.

For example, if Drug A and Drug B both treat your medical condition, Paramount may prefer Drug A, and require you to try it first. If Drug A does not work for you, Paramount will then cover Drug B. The listed preferred products should be used first. An exception process is in place for specific circumstances that may warrant a need for a non-preferred product.

Part B Step Therapy Requirements

Complaints and Grievances

We work hard to ensure that your experience as a Paramount Elite member is the best that it can be, however, things don’t always go as planned. The Medicare Advantage grievance process is available to all of our Paramount Elite members and is used to address things like coverage issues, complaints, and problems related to your health plan and the healthcare items and services that you receive while you are a member.

How to File a Grievance

If you would like to make a complaint (which is what we refer to as “file a grievance”) about any of our services, your benefit package, or the treatment you received from a provider, a facility, or a pharmacy, you or your appointed representative can file a grievance. You (or your appointed representative) can also file a grievance if you discover an error in our records that you would like to have corrected.

You can file your grievance (make your complaint) with us by phone or in writing by fax, letter, or email (our contact information appears below), however, we need to be notified within 60 days after you experienced the problem, were unhappy with services, or found the error. .

Your grievance (complaint) can include any dissatisfaction that you have with your Medicare Advantage plan benefits, any of the services or communications that we have provided to you, and/or anything that you experienced related to your healthcare that you believe should have been handled differently. This includes any grievance (complaint) that you have about the quality of the care you received from a provider (doctor, nurse, hospital, urgent care, and any of their representatives) or the way a pharmacy handled filling your prescription.

Please note that we also have an appeal process that you will need to use when your grievance (complaint) is regarding the amount that was paid on a claim or the way your benefits were applied (as shown on your Explanation of Benefits, or “EOB”). You would also need to file an appeal if you disagree with a decision to deny a request for healthcare services, Part B drugs, or Part D prescription drugs.

If your grievance (complaint) is about your request for coverage or any payments that were made or not made by the plan, you should look at the section on this site regarding making an appeal first.

For more information on making a complaint (grievance) or filing an appeal about your plan coverage, healthcare services or items received, Part B drugs, or Part D prescription drugs, please refer to your Evidence of Coverage.

Paramount is able to accept a grievance (complaint) verbally or in writing directly from you (or your appointed representative) within the timeframe stated above. Complaints that qualify as standard grievances will be responded to within 30 calendar days of receipt. Complaints that are related to appeals and that qualify as expedited grievances will be responded to within 24 hours of receipt.

Either Paramount or the person who filed the grievance (who may be you or your appointed representative) can add a 14-calendar day extension to give us more time to resolve or respond to your grievance. If we extend the timeframe, a letter will be mailed to the person who filed the grievance (who may be you or your appointed representative). This letter will explain the reason for the delay and why the delay (extra time for investigation) will help allow us to resolve the grievance in your best interest. Again, please refer to your plan’s Evidence of Coverage for additional information and a complete description of the complaint (grievance) process.

To file a grievance within 60 days, contact us using one of the following methods:

Phone

Call 833-554-2335 to talk with a Member Services representative. If you use TTY telephone equipment, call 711.

Member Services representatives are available:

April 1 through September 30: Monday – Friday, 8 a.m. – 8 p.m. (closed Memorial Day, Independence Day and Labor Day)
October 1 through March 31: seven days a week, 8 a.m. – 8 p.m. (closed on Thanksgiving and Christmas)

Fax

Fax your written complaint letter to 419-887-2037, Attention: Grievances, Member Services

Mail

Mail your written complaint letter to:

Paramount
Attention: Grievance Coordinator, Member Services Dept.
P.O. Box 928
Toledo, OH 43697-0928

Email

Email your written request to: PHCMbrSvcAppeals@MedMutual.com.

Online

File a grievance using the Medicare Electronic Complaint form [OC1]. Your complaint will be sent to us by Medicare.

View your plan's Evidence of Coverage for a complete description of the grievance process.

Medicare Ombudsman

The Medicare Ombudsman helps you with Medicare-related complaints, grievances and other information requests. Your Medicare Ombudsman can make sure that you have information regarding your Medicare rights and protections and help you understand how to get your Medicare-related concerns resolved. If you have a Medicare-related concern that has not been resolved by Medicare or your plan, you can learn more by visiting the Medicare website.

Prescription Drug Information

Prior Authorization

Prior Authorization Criteria

View the prior authorization guidelines link here

Step Therapy Criteria

View the step therapy guidelines link here

Prescription Drug Coverage Determination and Redetermination Request

Coverage Determination or Coverage Exception

A coverage determination is a decision we make about your benefits and coverage, or about the amount we will pay for your Part D prescription drugs.

You, your appointed representative or your prescriber have the right to request a coverage determination in the following ways:

Call 855-749-0851 to speak with a CVS Caremark customer service representative 24 hours a day, seven days a week. TTY users can call 711.
Fax a request to CVS Caremark at 855-633-7673, Attention: CVS Caremark Part D Services Appeals and Exceptions.
Submit an online Coverage Determination Form directly from our website.
Send a written request to: CVS Caremark Part D Services Appeals and Exceptions, P.O. Box 52000 MC 109, Phoenix, AZ 85072-2000
Email: Paramount.MemberServices@MedMutual.com

When To Request an Appeal for Part D Prescription Drugs

When CVS Caremark sends you a letter or a claim to let you know of its decision to either cover or deny your Part D prescription drugs, that first decision is called a “coverage determination.” If you disagree with any decision made by CVS Caremark that is related to the coverage of any of your Part D prescription drugs, please consult your current Paramount Drug Formulary (also called the List of Covered Drugs) first. If you still disagree with CVS Caremark’s decision after reviewing your current Drug Formulary, please contact CVS Caremark and request an appeal.

Please note that if CVS Caremark has not yet issued a decision regarding coverage of your requested Part D prescription drug(s), then you will not be able to request an appeal.

If your health condition or care plan requires an immediate response regarding coverage of a Part D prescription drug that you are waiting to receive, please contact CVS Caremark by phone at 855-749-0851 and/or review the section on requesting an Expedited Appeal. This section only discusses Standard Appeals, which do not require an immediate decision, based on your perceived health condition or health status.

Expedited Coverage Determination

If you or your prescriber believes that waiting 72 hours for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 72 hours could seriously harm your health, we will automatically give you a decision within 24 hours. If you do not obtain your prescriber's support for an expedited request, we will decide if your case requires a fast decision. You cannot request an expedited coverage determination if you ask us to pay you back for a drug you have already received.

For more information on asking for coverage decisions about your Part D prescription drugs, please see Chapter 9 of your Evidence of Coverage.

Coverage Redetermination or Appeal

If your coverage determination for a prescription drug was denied, you have the right to ask us for a redetermination (appeal) of our decision. You have 65 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.

A redetermination or appeal is a formal way of asking us to review and change the coverage decision we have made.

You, your appointed representative or your prescriber have the right to request a coverage redetermination in the following ways:

Call 855-749-0851 to talk with a CVS Caremark customer service representative. You may call any time, 24 hours a day, seven (7) days a week. If you use TTY telephone equipment, please call 711.
If you have NOT ALREADY PAID for your Part D prescription drug out of pocket, you may FAX your written appeal request letter to 1-855-633-7673, Attention: CVS Caremark Part D Services Appeals and Exceptions
You may submit your request using the online CVS Caremark Request for Redetermination form directly from this website.
If you have not already paid for your Part D prescription drug out of pocket, you may mail your written appeal request to: CVS Caremark, Appeals Dept., MC109, PO Box 52000, Phoenix, AZ 85072-2000.
If you have already paid for your Part D prescription drug out of pocket and would like to request reimbursement, you may fax your written reimbursement request to 855-230-5549, Attention: CVS Caremark Part D Services Appeals and Exceptions Paper Claims
If you have already paid for your Part D prescription drug out of pocket and would like to request reimbursement, you may mail your written reimbursement request to: CVS Caremark, Part D Services Appeals and Exceptions, Paper Claims, PO Box 52066, Phoenix, AZ 85072-2066.

Expedited Redetermination

If you or your prescriber believes that waiting 7 days for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 7 days could seriously harm your health, we will automatically give you a decision within 72 hours. If you do not obtain your prescriber's support for an expedited appeal, we will decide if your case requires a fast decision. You cannot request an expedited appeal if you are asking us to pay you back for a drug you have already received.

You have several ways to request an expedited appeal:

Call 567-585-9888 or toll free at 855-749-0851 to speak with a CVS Caremark customer service representative 24 hours a day, seven days a week. TTY users can call 711.
Fax a request to 1-855-633-7673, Attention: CVS Caremark Part D Services Appeals and Exceptions.
Fax a reimbursement request to 1-855-230-5549, Attention: CVS Caremark Part D Services Appeals and Exceptions Paper Claims.
Send a written request to: CVS Caremark Part D Services Appeals and Exceptions P.O. Box 52000 MC 109, Phoenix, AZ 85072-2000.
Send a written reimbursement request to: CVS Caremark Part D Services Appeals and Exceptions Paper Claims P.O. Box 52066, Phoenix, AZ 85072-2066.
Submit an online Redetermination Form directly from our website.
For more information on asking for a coverage redetermination or appeal a decision about your Part D prescription drugs, please see Chapter 9 of your Evidence of Coverage.

If Your Appeal Is Denied

If Paramount Elite denies any part of your appeal request for a coverage or payment review of a Part D prescription drug, we will inform you of our decision, and explain your further appeal rights, which will instruct you how to exercise those rights. Part D prescription drug appeals must be requested by you for review at C2C Innovative Solutions, Inc. Requests for an independent review of Part D prescription drug appeals must come from you.

C2C will notify you in writing when they have decided on your case, including the reasons for that decision. If they deny any part of your appeal, they will send you information about any remaining appeal rights you have.

Information on your right to file appeals is also included in your Evidence of Coverage. If you have questions, you can also call us toll free at 1-800-982-3117 (TTY: 711 for hearing impaired) for help. We are open 8 a.m. to 8 p.m. seven days a week from October 1 to March 31 (excluding Thanksgiving and Christmas Day). From April 1 to September 30, we are open Monday through Friday from 8 a.m. to 8 p.m.

You may also contact the Medicare Rights Center at 1-800-333-4114 (TTY: 711 for hearing impaired) for help. The Medicare Rights Center is a non-profit organization providing counseling and advocacy services to support access to affordable healthcare. Or you may contact Medicare directly at 1-800-MEDICARE, 24 hours a day, seven days a week. (TTY: 1-877-486-2048 for hearing impaired).

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a payment option that works with your current Medicare Part D drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Anyone with a Medicare Part D drug plan or Medicare drug coverage can use this payment option. All plans offer this payment option and participation is voluntary. If you are currently enrolled in the Medicare Prescription Payment Plan for 2025 and want to remain enrolled for 2026 you do not need to do anything. You will remain enrolled for the 2026 benefit year.

If you select this payment option, you will get a bill from Paramount to pay for your prescription drugs (instead of paying the pharmacy). There is no cost to participate in the Medicare Prescription Payment Plan.

Learn More

Medication Adherence

Taking medications as directed by your doctor or healthcare provider is often referred to as medication adherence. Filling your prescriptions and taking medications as directed by your doctor or healthcare provider are important parts of managing your health. To prevent serious complications, you should take your medications exactly as prescribed — even if you don’t feel any symptoms. Many common generic medications for treating high blood pressure, high cholesterol and diabetes have low or $0 copay for up to a 90-day supply at preferred network pharmacies, including Express Scripts home delivery. Show your Paramount Elite Medicare Advantage card at the pharmacy and ask that they use it for all medications covered by your plan.

Medicare Part D Drug Transition Policy

New members in our health plan may be taking drugs that are not on our formulary (list of drugs) or that are subject to certain restrictions, such as prior authorization, quantity limits or step therapy. Current members may also be affected by changes in our formulary from one year to the next. If your drug is not on the Drug List or is restricted, here are things you can do:

You may be able to get a temporary supply of the drug (only members in certain situations can get a temporary supply). This will give you and your provider time to change to another drug or to file a request to have the drug covered.
You can change to another drug.
You can request an exception and ask the plan to cover the drug or remove restrictions from the drug.

You may be able to get a temporary supply.

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.

To be eligible for a temporary supply, you must meet the two requirements below:

The change to your drug coverage must be one of the following types of changes:
1. The drug you have been taking is no longer on the plan's Drug List.
2. or -- the drug you have been taking is now restricted in some way.
3. Or - Part D drugs previously approved for coverage under an exception once the exception expires
You must be in one of the situations described below:
1. For those members who are new or who were in the plan last year:
  1. We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
2. For those members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away:
  1. We will cover one 31-day supply of a particular drug, or less if your prescription is written for fewer days. This is in addition to the above temporary supply situation.
3. For those members who have been in the plan for more than 90 days and experience a level of care change (from one treatment setting to another):
  1. We will provide up to a one-month supply of a Non-Formulary Drug and/or a drug that may be restricted in some way, or less if your prescription is written for fewer days.
4. Other times when we will cover a temporary 31-day transition supply (or less, if you have a prescription written for fewer days) include:
  1. When you enter a long-term care facility
  2. When you leave a long-term care facility
  3. When you are discharged from a hospital
  4. When you leave a skilled nursing facility

The plan will send you a letter within three business days of your filling a temporary transition supply, notifying you that this was a temporary supply and explaining your options.

Our transition supply will not cover drugs that Medicare does not allow Part D plans to cover, such as drugs used for erectile dysfunction or drugs for weight loss.
For more information regarding our Medicare Part D Transition Process please call our Member Services team at 1-833-554-2335 (TTY: 711 for hearing impaired). From April 1 to Sept. 30, representatives are available Monday – Friday, 8 a.m. – 8 p.m. (except Memorial Day, Independence Day and Labor Day). From Oct. 1 to March 31, representatives are available seven days a week, 8 a.m. – 8 p.m. (except Thanksgiving and Christmas).

You and/or your provider can ask the plan to make an exception for you and cover the drug in the way you would like it to be covered. If your provider says that you have medical reasons that justify asking us for an exception, your provider can help you request an exception to the rule. For example, you can ask the plan to cover a drug even though it is not on the plan's Drug List. Or you can ask the plan to make an exception and cover the drug without restrictions. If you and your provider want to ask for an exception, Chapter 9, Section 6.4 of the Evidence of Coverage tells what to do. It explains the procedures and deadlines that have been set by Medicare to make sure your request is handled promptly and fairly.

Quality Assurance

What is quality assurance?

Our quality assurance team ensures that – together with you and your doctor – we make the best healthcare decisions for you and your health needs. Part of that includes making sure you have access to the most appropriate services and medications provided by our health plan.

When it comes to Medicare Part D, our team carefully follows processes that review your prescriptions for your safety and good health.

Concurrent Drug Utilization Review

When a prescription is being filled at the pharmacy, it is reviewed for safety issues including:

Medication errors
Drug dosage (dose) and therapy duration (length of treatment) errors
Duplicate drugs – taking two drugs to treat the same medical condition when only one is necessary
Drug allergies
Harmful interactions between the drugs you are taking
Drugs that are not appropriate for your age or gender

Retrospective Drug Utilization Review

Retrospective Drug Utilization Review occurs after a prescription is filled. This process:

Reviews members’ drug histories
Identifies opportunities to improve quality of care by uncovering inappropriate or medically unnecessary medications

When it comes to Medicare Part D, our team carefully follows processes that review your prescriptions for your safety and good health.

Medicare Part D Utilization Management

What is drug utilization management?

Our drug utilization management team wants to make sure that you are taking the right drug for the right length of time to best treat your medical condition. They use special systems that help prevent over- and under-utilization of prescribed medications. By carefully reviewing the medications that our members take, we can help improve health and, as appropriate, reduce medication costs. Tools we use to accomplish this include:

Prior Authorizations

For some drugs, you or your provider may need to get an approval from Paramount before the drug is covered. This is called prior authorization. Sometimes requiring approval in advance helps guide appropriate use of certain drugs. If you or your prescriber don’t submit a prior authorization, your drug may not be covered by your health plan.

Quantity Limits

For your safety, we may limit the amount of certain drugs that you can get each time you fill your prescription. For example, if it’s normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill a day.

Step Therapy

Based on best practices, we may require you to try certain drugs to treat your medical condition before we will cover a different drug for the same condition. For example, if Drug A and Drug B both treat your medical condition, the plan may not cover Drug B unless you try Drug A first. However, if Drug A does not work for you, the plan will then cover Drug B.

Generic Drugs

Usually, a generic drug works the same as a brand name drug and costs less. In most cases, when a generic version of a brand name drug is available, our network pharmacies will dispense the generic version. We typically will not cover the brand name drug when a generic is available. However, if your doctor requests the brand then we may cover it in certain instances.

Note: Your share of the cost may be greater for the brand name drug than for the generic drug.

Pharmaceutical Assistance Programs

Pharmaceutical Assistance Programs (PAPs) are sometimes available to help relieve financial burden by providing free or discounted medications to qualifying patients. These programs are medication specific and may be available to you through various organizations. See if a program is available for your medication.

Prescription Mail-order Services

Save on the medications you take regularly, such as high blood pressure or diabetes medicine, with 90-day refills from CVS Caremark Mail Service Pharmacy. It’s an easy way to make sure you have the medication you need, when you need it – making refilling these prescriptions one less thing to worry about.

Call CVS toll free at 855-749-0851 to set up your mail order account.

CVS will need to know your healthcare provider’s name and phone number, the name and strength of the medication, any allergies, and your payment information. CVS will contact your healthcare provider to obtain a new 90-day prescription for your medication.

Once your prescription is received from your provider, CVS will call you to confirm order details and begin the shipment process. New prescriptions will be mailed to you within 10 to 14 days after CVS receives your prescription.

Out-of-network Pharmacy Coverage and Prescription Drug Claim Form

Using a pharmacy that’s not in our plan's network

Generally, we cover drugs filled at an out-of-network pharmacy only when you aren’t able to use a network pharmacy. We also have network pharmacies outside of our service area where you can get prescriptions filled as a member of our plan. Check first with Member Services at 1-833-554-2335 (TTY users call 711) to see if there’s a network pharmacy nearby. We cover prescriptions filled at an out-of-network pharmacy only in these circumstances:

If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24- hour service. Out-of-network pharmacy fills are limited to a 30-day supply.
If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail-order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals). Out-of-network pharmacy fills are limited to a 30-day supply.
If the prescriptions are related to care for a medical emergency or urgently needed care, they will be covered. In this situation, you will have to pay the full cost (rather than paying just the copayment or coinsurance) when you fill your prescription. You can ask us to reimburse you by submitting a paper claim to us for up to usual, customary, and reasonable (UCR). Any amount you pay over the UCR will be applied to your Part D Out-Of-Pocket Costs.
If you are traveling within the United States, but outside the plan's service area, and you become ill or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy (if you follow all other coverage rules identified within this document and a network pharmacy is unavailable). In this situation, you will have to pay the full cost (rather than paying just the copayment or coinsurance) when you fill your prescription. You can ask us to reimburse you by submitting a paper claim to us for up to usual, customary, and reasonable (UCR). Any amount you pay over the UCR will be applied to your Part D Out-of-Pocket Costs.
If you are unable to get a covered drug in a timely manner within our service area, because there is not a network pharmacy within a reasonable driving distance which provides 24-hour service.
If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail-order pharmacy (these drugs include orphan drugs or specialty pharmaceuticals).
Self-administered medications that you receive in an outpatient setting may be covered under Part D. For consideration, please submit a paper claim.

If you must use an out-of-network pharmacy, you’ll generally have to pay the full cost (rather than your normal cost share) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost. (For more information on how to ask our plan to pay you back, see Chapter 7, Section 2 of your EOC.) You may be required to pay the difference between what you pay for the drug at the out-of-network pharmacy and the cost we would cover at an in-network pharmacy.

How do you ask for reimbursement from the plan?

If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You may request reimbursement for your share of the cost by submitting a paper claim to Medical Mutual. You may, however, be required to pay the difference between what you pay for the drug at the out-of-network pharmacy and the cost that we would cover at an in-network pharmacy.

This Prescription Drug Claim Form is offered as a tool to assist in getting your claim paid as soon as possible. Please print clearly. Use of this particular form is not required and you may submit equivalent written documentation, but it must provide all of the requested information on this form.

Please review your Evidence of Coverage for complete information about out-of-network pharmacy coverage and how to submit a paper claim for reimbursement, or call Member Services at PAR customer service (TTY: 1-800-716-3231 for hearing impaired).

Medication Therapy Management

Help for Your Prescription Medications

The Paramount Elite Medication Therapy Management (MTM) Program is all about you and your health. The MTM Program helps you get the most out of your medications by:

Preventing or reducing drug-related risks
Supporting good lifestyle habits
Providing information for safe medication disposal options

FAQ

Who qualifies for the MTM Program?
You will be enrolled in the Paramount Elite MTM Program if you meet one of the following:

Meet the following criteria:
- You have three or more of these conditions:
  - Alzheimer’s disease
  - Bone disease – arthritis (osteoarthritis, osteoporosis, rheumatoid arthritis)
  - Chronic congestive heart failure
  - Diabetes
  - Dyslipidemia
  - End-stage renal disease
  - HIV/AIDS
  - Hypertension
  - Mental health (depression, schizophrenia, bipolar disorder, chronic/disabling mental health conditions)
  - Respiratory disease (asthma, COPD, chronic lung disorders)
- You take eight or more routine medications covered by your plan.
- You are likely to spend more than $1,276 in Part D prescription drug costs in 2026.
OR
You are identified as an At-Risk Beneficiary (ARB) under our Drug Management Program.

Your participation in the MTM Program is voluntary and does not affect your coverage. This is not a plan benefit and is open only to those who qualify. There is no extra cost to you for the MTM Program.

How will I know if I qualify for the MTM Program?
If you qualify, we will mail you a letter. You may also receive a call to set up your one-on-one medication review.

What services are included in the MTM Program?
In the MTM Program, you will receive the following services from a health care provider:

Comprehensive medication review
Targeted medication review

What is a comprehensive medication review?
The comprehensive medication review is completed with a health care provider in person or over the phone. This review is a discussion that includes all your medications:

Prescriptions
Over-the-counter (OTC)
Herbal therapies
Dietary supplements

This review usually takes 20 minutes or less to complete. During the review, you may ask any questions about your medications or health conditions. The health care provider may offer ways to help you manage your health and get the most out of your medications. If more information is needed, the health care provider may contact your prescriber.

After your review, you will receive a summary of what was discussed. The summary will include the following:

Recommended To-Do List. Your to-do list may include suggestions for you and your prescriber to discuss during your next visit.
Medication List. This is a list of all the medications discussed during your review. You can keep this list and share it with your prescribers and/or caregivers.

Who will contact me about completing the review?
You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You can choose to complete the review in person or over the phone.

A health care provider may also call you to complete your review over the phone. When they call, you can schedule your review at a time that is best for you.

Trusted MTM Program partners: You may receive a call from the CVS Caremark Pharmacist Review Team or the Outcomes Patient Engagement Team to complete this service.

What is a targeted medication review?
The targeted medication review is completed by a health care provider who reviews your medications at least once every three months. With this review, we mail, fax, or call your prescriber with suggestions about prescription drugs that may be safer or work better for you. As always, your prescriber will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your prescriber decide to change them. We may also contact you by mail or phone with suggestions about your medications.

Why is this review important?
Different prescribers may write prescriptions for you without knowing all the medications you take. For that reason, the MTM Program health care provider will:

Review all your medications
Discuss how your medications may affect each other
Identify any side effects from your medications
Help you reduce your prescription drug costs

How do I benefit from talking with a health care provider?
By completing the medication review with a health care provider, you will:

Understand how to safely take your medications
Get answers to any questions you may have about your medications or health conditions
Review ways to help you save money on your drug costs
Receive a Recommended To-Do List and Medication List for your records and to share with your prescribers and/or caregivers

How can I get more information about the MTM Program?
Please contact us if you would like more information about the Paramount Elite MTM Program or if you do not want to participate. Our number is 833-554-2335, a Member Services representative is available Monday – Friday, 8 a.m. – 8 p.m. Note: From October 1 through March 31, we are available 8 a.m. – 8 p.m., seven days a week. If you use TTY telephone equipment, call us at 711.

How do I safely dispose of medications I don’t need?
The Paramount Elite MTM Program provides you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications.

Locating a community safe drug disposal site A drug take back site is the best way to safely dispose of medications.
- Find drug take back sites near you by entering your location.
- Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for disposal options near you.
Mailing medications to accepting drug disposal sites
- Medications may be mailed to authorized sites using approved packages. Information on mail-back sites can be found at www.deatakeback.com.
Safe at-home medication disposal
- You can safely dispose of many medications through the trash or by flushing them down the toilet. Learn what medications are safe to dispose of at home.
Steps for medication disposal in the trash:
- Remove medication labels to protect your personal information
- Mix medications with undesirable substances, such as dirt or used coffee grounds
- Place mixture in a sealed container, such as an empty margarine tub

Drug Management Program

Paramount is committed to ensuring the safe use of all prescription medications. The Paramount Drug Management Program (DMP) focuses on the safe use of opioids, benzodiazepines and other frequently abused drugs. This program helps coordinate care for Medicare members who get opioid prescriptions from multiple doctors or pharmacies.

Throughout the year, Paramount will review opioid medication usage and identify members who would benefit from our DMP. If we find possible unsafe usage or overuse of prescription opioids, benzodiazepines and other frequently abused drugs we typically contact your prescriber to better coordinate care. Based on these discussions and the outcome of this review, we may add certain limits on your coverage for these types of drugs. For example, members may be required to get these medications from certain doctors or pharmacies. You will be notified in writing if this occurs.

If you think that we’ve made a mistake or would like to appeal this determination, you, your doctor or authorized representative can file an appeal. You should review the information contained in your notification letter for more information about how to request an appeal or visit our Coverage Redetermination and Appeal section.

For more information about the DMP or how to submit an appeal, call Member Services at 1-833-554-2335 (TTY: 711 for hearing impaired).

Part D Forms

Medicare Part D Authorization Request Forms

Medicare Part D Electronic Submission

Other Plan Information

Appointment of Representative

You Can Ask Someone to Act on Your Behalf

If you would like to name another person to act as your representative so that this person can contact Paramount and CVS Caremark and make requests for you, please call Member Services and ask for the Appointment of Representative form (called the “AOR” form). The AOR form gives this person (your representative) the authority to contact Paramount and CVS Caremark and act on your behalf for one (1) year after the date of the signatures on your form. You must enter all of your information and your representative’s information onto the AOR form and both of you must sign it.

If you want to appoint a representative but you don’t want to use the AOR form, you may write or type your own appointment of representative letter, however, your letter must contain the same information that is required on the AOR form. You may appoint any person over the age of 18 years to be your representative for this purpose. Also, please know that you do not need to be related to person whom you are appointing as your representative.

Once you have the form completely filled out and signed, or you have written your own form letter, and both you and your representative have signed it, you must send it to Paramount Member Services either by mail, fax, email (please ask us how to send it securely), or in person at our Beaver Creek location in Maumee. Your representative will not be able to make any requests with Paramount on your behalf until Paramount receives and accepts your request to appoint this person as your representative.

After Paramount receives and accepts your AOR form (or your own written form letter), then your representative may contact Paramount or CVS Caremark and make requests for you (such as an initial determination, appeal, or complaint) for a period of one (1) year after your form (or letter) was signed.

PLEASE NOTE: Your representative will be acting on your behalf, so your representative will receive all of the updates and written notices, including decision notices, that are related to any request that was filed for you by your representative. You may request a copy of any of these notices at any time by calling Member Services.

You do not need to appoint a representative to act on your behalf, unless you want to. Appointing a representative does not take away or replace your authority to contact Paramount or to request an initial determination, appeal, or grievance (complaint) on your own. Appointing a representative simply gives you the choice of filing a request yourself or asking your representative to file a request on your behalf.

Getting Care During a Disaster

Per your Evidence of Coverage, if the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to receive care through your plan. If you cannot use a network provider during a declared disaster, your plan will allow you to obtain care from any out-of-network provider at the in-network cost sharing rate(s). If you cannot use a network pharmacy during a disaster, you may be able to fill your prescription drugs at an out-of-network pharmacy. As always, contact Member services with any questions or for assistance.

Best Available Evidence

In certain cases, the Centers for Medicare and Medicaid Services (CMS) may give you incorrect information on your low-income subsidy status. The Best Available Evidence policy allows us to use “best available evidence” in these cases to help determine your correct low-income subsidy status.

If you believe you have been given incorrect information on your low-income subsidy status, please send us one or more of the following:

A copy of your Medicaid card that includes your name and an eligibility date during a month after June of the previous calendar year.
A copy of a state document that confirms active Medicaid status during a month after June of the previous calendar year.
A print out from the State electronic enrollment file showing Medicaid status during a month after June of the previous calendar year.
A screen print from the State’s Medicaid systems showing Medicaid status during a month after June of the previous calendar year.
Other documentation provided by the State showing Medicaid status during a month after June of the previous calendar year.
For individuals who are not deemed eligible, but who apply and are found LIS eligible, a copy of the SSA award letter.

If you are institutionalized, please send us one or more of the following:

A remittance from the facility showing Medicaid payment for a full calendar month during a month after June of the previous calendar year.
A copy of a state document that confirms Medicaid payment on your behalf to the facility for a full calendar month after June of the previous calendar year.
A screen print from the State’s Medicaid systems showing your institutional status based on at least a full calendar month stay for Medicaid payment purposes during a month after June of the previous calendar year.

For more information on the Best Available Evidence policy, please visit the CMS webpage.

Disenrollment Information

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period (October 15 to December 7) and during the annual Open Enrollment Period (January 1 to March 31). In certain situations, you may also be eligible to leave the plan at other times of the year (also known as a Special Enrollment Period).

Usually, to end your membership in our plan, you simply enroll in another Medicare plan during one of the enrollment periods. 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 would like to be disenrolled, you can make a request in writing to us.

Paramount
Attn: Membership Dept.
300 Madison Ave., 3rd Floor
Toledo, OH 43604

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. ("Creditable" coverage means the coverage is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage.)

In most cases disenrollment from a plan is your choice (voluntary) but, in some circumstances you may not have a choice (involuntary). There are situations which require you to leave a plan such as:

You lose your Part A benefits and/or are no longer enrolled in Part B
You fail to pay your plan premium

Disenrollment from a Medicare Advantage plan is subject to CMS rules. For more information about disenrolling from our plan or your rights and responsibilities, please review your plan's Evidence of Coverage.

If you have questions about disenrollment, you may contact Member Services at 567-585-9888 or toll free 1-833-554-2335 (TTY 711). From April 1 through September 30, we are open 8 a.m. to 8 p.m., Monday through Friday (closed Memorial Day, Independence Day, and Labor Day). From October 1 through March 31, we are open 8 a.m. to 8 p.m., seven days per week (closed on Thanksgiving and Christmas).

Payment Information

We make paying your premium easy. There are four ways you can pay your monthly premium directly to Paramount.

Receive a bill in the mail each month. Then send in your payment.
Pay by automatic bank draft. If you are interested in this payment option, please complete the bank draft form and send it to us.
Have your premium automatically deducted from your monthly Social Security check (SSA) or Railroad Retirement Board (RRB) benefit check.
Note: Once the Social Security Administration (SSA) or Railroad Retirement Board (RRB) approves the deduction, it may take two or more months to begin.
Manage your account online.
- Pay Now allows you to make a one-time payment.
- Pay My Bill allows you to enroll in our paperless invoice and payment system.
- After you receive your first monthly invoice, you can also sign up for paperless billing at Pay My Bill.
- Manage Your Account Online

If you need assistance, call Member Services at 567-585-9888.

Michigan Counties: Branch, Hillsdale, Lenawee, Monroe and Washtenaw

Ohio Counties: Fulton, Lucas, Ottawa, Sandusky and Wood

Page last updated on 10/1/2025
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