Sterling Health Plans. Real people. Wise choices

Windsor Rx PDP Plans

Windsor Rx is a standalone Part D Prescription Drug Plan available to all Medicare beneficiaries residing in our service area. Through our contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare, Windsor Rx provides comprehensive prescription drug coverage to persons enrolled in Original Medicare.

Windsor Medicare RX 

windsor-rx
 

Frequently Asked Questions

To learn more about enrolling in Windsor Rx, a product of Windsor Health Plan, Inc., a Medicare-approved Part D sponsor, please review these important questions below.

When to enroll
Annual Enrollment Period (AEP)
Can anyone enroll?
If You Have Employer or Union Prescription Coverage
Methods for enrolling into Windsor Rx
What drugs does the Windsor Rx plan cover?
What pharmacies can I go to?
Mail order
Getting Help Paying for the Costs of Prescription Drug Coverage
Are my drugs covered?
Appeals & Grievances
Quality Assurance Policies and Procedures
What is "Disenrollment"?
How to Disenroll
Important Contacts
PDP Plan Ratings

 
BACK TO TOP

When to enroll

The Initial Enrollment Period for Part D (IEP for Part D) is the period during which you are first eligible to enroll in a Part D plan. In general, an individual is eligible to enroll in a Part D plan when he or she is entitled to Part A and/or enrolled in Part B, and permanently resides in the service area of a Part D plan. Individuals eligible for Medicare prior to age 65 (such as for disability) will have another Initial Enrollment Period for Part D based upon attaining age 65.

Each year Medicare provides an Annual Enrollment Period so beneficiaries can sign up for the first time or switch plans. There are exceptions throughout the year that may allow you to make plan changes outside of the initial Enrollment Period or Annual Enrollment Period. To find out if you qualify, contact Customer Service.

BACK TO TOP 

Annual Enrollment Period (AEP)

Each year Medicare provides an enrollment period so beneficiaries can sign up for new coverage or switch to a different plan. The AEP occurs October 15 through December 7 of every year. If you take advantage of the AEP, your new coverage will begin January 1.

BACK TO TOP

Can anyone enroll?

If you are enrolled in a Medicare Advantage (MA) coordinated managed care plan (HMO or PPO) or an MA private fee-for-service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a stand-alone PDP unless you disenroll from the HMO, PPO, or PFFS plan. Enrollees in a PFFS plan that does not provide Medicare prescription drug coverage, or an MA Medical Savings Account (MSA) plan, may enroll in a PDP. Enrollees in an 1876 Cost plan may enroll in a PDP.

If you join the Windsor Rx stand-alone drug plan, you may still keep your Original Medicare. Another choice you have is to join a Medicare Advantage with Prescription Drug (MA-PD) coverage, which is also offered by Windsor Medicare Extra for all of your medical and prescription drug needs. You can learn more about these plans, or call us at 1-800-316-2273 (TTY for the hearing impaired 711) from 8:00 a.m. to 8:00 p.m., Monday through Friday.

BACK TO TOP 

If You Have Employer or Union Prescription Coverage

If you have prescription drug coverage from a former or current employer or union, contact your benefits administrator before you make any changes to your drug coverage. If you join a Medicare Prescription Drug Plan or Medicare Advantage Plan, you and your family may lose your employer or union coverage.

BACK TO TOP

Methods for enrolling into Windsor Rx

  • You must complete a Windsor Rx enrollment form and mail it to us, or;
  • Enroll online on the Windsor website, or;
  • Enroll through Medicare by calling 1-800-MEDICARE (1-800-633-4227) or toll free at 1-800-633-4227; (TTY/TDD users call 1-877-486-2048), 24 hours-a-day, 7 days-a-week, or;
  • Go to the Medicare website: http://www.medicare.gov: or;
  • Enroll by phone with a Windsor enrollment counselor, or;
  • Have a legal authorized representative enroll you through one of the above methods.

Once Windsor receives notice from Medicare, we will send you a notice of confirmation of enrollment, rejection of enrollment, or a denial of enrollment and the reason.

BACK TO TOP

What drugs does the Windsor Rx plan cover?

Windsor Rx has a list of covered drugs called a formulary. Our formulary includes at least two drugs (and in some cases all drugs) in all classes of drugs most commonly prescribed to people with Medicare. This makes sure that people with different medical conditions can get the treatment they need. The list can change during the year because drug therapies change, and new drugs and medical knowledge become available. If you are affected by the change, your plan will notify you at least 60 days before the formulary changes. If there is a formulary change that affects a drug you take, in most cases it will still be covered for you until the end of the year.

Be sure to look over your current prescription drug coverage and ask yourself the following questions:

Are prescription drugs covered?
Are my prescription drugs covered?
What are the out-of-pocket costs?

BACK TO TOP

What pharmacies can I go to?

Windsor Rx provides prescription drug benefits through a network of pharmacies. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Windsor Rx. Windsor Rx has an extensive list, or directory, of network pharmacies that is mailed to you when you become a Windsor Rx member.

To find a network pharmacy you can call our Customer Service department at 1-800-264-1587, 24 hours day, seven days a week (TTY/TDD users should call 711).

In most cases, your formulary prescriptions are covered if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to a pharmacy, you are not required to continue going to that same pharmacy to fill your prescription. You can go to any of our network pharmacies.

BACK TO TOP

Mail order

We also offer a mail-order program that will allow you to have drugs sent directly to your home. To get order forms and information about filling your prescriptions by mail, contact CVS/Caremark by phone at 1-800-262-9129, 24 hours a day, seven days a week. (TTY/TDD users should call 711.)

BACK TO TOP 

Getting Help Paying for the Costs of Prescription Drug Coverage

If you have Medicare and have limited income and resources, you may qualify for extra help paying for prescription drugs. If you qualify, Medicare could pay up to 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Persons eligible for Medicaid, Supplemental Security Income (SSI), or a Medicare Saving Program qualify for the extra help automatically and do not need to apply. All others may apply with the Social Security Administration (SSA) by mail, by telephone, on the Internet at http://www.socialsecurity.gov or in person at a community event or an SSA office. Applications may also be filed at a local Medicaid office.

Click here to access Medicare's web site for requirements on low income subsidy, or call the Medicare Service Center at 1-800-MEDICARE (1-800-633-4227) TTY: 1-866-226-1819, 24 hours a day/seven days a week.

BACK TO TOP 

Are my drugs covered?

A formulary is a list of drugs selected by Windsor Health Plan, Inc., for coverage by our Windsor Rx plan. This formulary is reviewed and approved by Medicare. Windsor Rx plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Windsor network pharmacy, and other plan rules are followed. Windsor may add or remove drugs from the formulary during the year. We will provide 60-day notice regarding removal or change in the preferred or tiered cost-sharing status of a Part D drug.

BACK TO TOP

Appeals & Grievances

Members of Windsor Rx have the right to appeal any decisions we make related to prescription drug benefits, including but not limited to a denial, termination, payment or reduction of services. You can also access the grievance and appeal process here, Appeals & Grievances.

BACK TO TOP

Quality Assurance Policies and Procedures

Windsor Health Plan, Inc., is dedicated to administering benefits to our Windsor Rx plan members effectively and efficiently. We are committed to providing our members access to high quality, comprehensive and cost effective medical care. The intent of Windsor Health Plan’s Quality Improvement Program is to support contracted providers in order to continually improve the quality and cost effectiveness of services provided to Windsor Rx plan members, and to support the effective and efficient administration of covered benefits. The scope of the Quality Improvement Program encompasses the populations covered by the Windsor Rx plan and is comprehensive, spanning the full range of clinical and health administrative services provided to all members.

BACK TO TOP

What is "Disenrollment"?

"Disenrollment" from your Windsor Rx plan means ending your membership in your Windsor Rx plan. Disenrollment can be voluntary (your own choice) or involuntary (not your own choice.) The first step is to be sure that the type of change you want to make and when you want to make it fit with the rules about election periods. Remember, there are limits to when you may leave, how often you can make changes, and what type of plan you can join after you leave.

There are also a few situations where you would be required to leave. Some of those situations are listed below:

If you do not stay continuously enrolled in Medicare Part A and/or Medicare Part B.
If you give us information on your enrollment form that you know is false or deliberately misleading, and it affects whether or not you can enroll in your Windsor Rx plan.
If you behave in a way that is disruptive, to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you. We cannot make you leave your Windsor Rx plan for this reason unless we get permission first from the Centers for Medicare & Medicaid Services, the government agency that runs Medicare.
If you let someone else use your plan membership card to get medical care. If you are disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation.
If you do not pay your applicable plan premiums, we will tell you in writing that you have a 2 months grace period during which you can pay the plan premiums before you are required to leave your Windsor Rx plan.
No member of any Medicare health plan can be asked to leave the plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave your plan because of your health, you should call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.

You have the right to make a complaint if we ask you to leave your Windsor Rx plan.

Whether leaving the plan is your choice or not, until your membership ends, you must keep getting your Medicare services through your Windsor Rx plan pharmacies or you will have to pay for them yourself. The exceptions are urgently needed care, care for a medical emergency, out-of-area renal (kidney) dialysis services, and care that has been approved by us.

BACK TO TOP

How to Disenroll

First, use any of the following ways to tell us that you want to leave your Windsor Rx plan:

You can enroll in another plan (during a valid enrollment period).

You can write or fax a letter to or fill out a disenrollment form and send it to Windsor Rx, Attention: Enrollment at 7100 Commerce Way Suite 285 Brentwood, TN 37027 or to our fax number at 1-615-782-7986. Be sure to sign and date your letter or form. To get a disenrollment form, call our Customer Service department at 1-800-264-1587. TTY users should call 711.

You can call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY Users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.

We will then send you a letter that tells you when your membership will end. In most cases, your disenrollment date will be the first day of the month that comes after the month we receive your request to leave.

BACK TO TOP

Important Contacts

Centers for Medicare and Medicaid Services (CMS)
7500 Security Blvd.
Baltimore, MD 21244-1850
1-800-633-4227, TTY: 1-877-486-2048.
24 hours a day, 7 days a week.

Medicare
1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users call 1-877-486-2048.
http://www.medicare.gov

Social Security Administration
6401 Security Blvd.
Baltimore, MD 21235
1-800-772-1213, TTY: 1-800-325-0778.
7 a.m. - 7 p.m.
http://www.ssa.gov/

BACK TO TOP

PDP Plan Ratings

Click here to see the Windsor Rx S2505 Plan Ratings and Windsor Rx S4802 Plan Ratings.

BACK TO TOP

 

Disclaimers

Windsor Rx (PDP) is a Medicare-Approved Part D sponsor. Enrollment in Windsor RX (PDP) depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

You must continue to pay your Medicare Part B premium.

Contact Us

  • Find a Plan
    My location not found