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Last Updated: 07/02/2018

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CMS Model Electronic Complaint Form	8am to 8pm 7 days a week October 1st to February 14th	Toll Free: 1-800-401-2740
The Medicare Beneficiary Ombudsman	8am to 8pm Mon. - Fri. February 15th to September 30th	TTY/TDD: 711
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Website Disclaimer

Freedom Health, Inc. is an HMO plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Freedom Health, Inc. depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Beneficiaries generally must use network pharmacies to access their prescription drug benefit. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Freedom Health through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Depending on the services, a prior authorization or referral from your doctor may be required.

For Chronic Special Needs Plans (SNP): These plans are available to anyone with Medicare who has been diagnosed with Diabetes, Cardiovascular Disease, Chronic Heart Failure, or a qualified Chronic Lung Disorder, such as Chronic Obstructive Pulmonary Disease (COPD), Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, or Pulmonary Hypertension.

For Dual Special Needs Plans (DSNP): These plans are available to anyone who has both medical assistance from the state and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Part B premium is covered for full dual members of Special Needs Plans.

Freedom Health, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Freedom Health, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-401-2740 (TTY: 711). Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-401-2740 (TTY: 711).

These materials may be made available in alternate formats (e.g., large print, Braille) to individuals with disabilities, upon request.

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