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  • Medicare Part D Coverage Determination Request Form For ...

Get Medicare Part D Coverage Determination Request Form For ...

Plan Name: Aetna Medicare Phone #: 1-800-414-2386 Fax #: 1-800-408-2386 Medicare Part D Coverage Determination Request Form for Prescribers . This form cannot be used to request: Medicare non-covered.

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The following are examples of when you can ask us for a Coverage Determination: If there is a limit on the quantity (or dose) of a drug and you disagree with the limit. If there is a requirement that you try another drug before we will pay for the drug you are asking for. If the copay for a drug is higher than expected.

What's a "Local Coverage Determination" (LCD)? LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC's jurisdiction (region) in ance with section 1862(a)(1)(A) of the Social Security Act.

A coverage determination (exception) is a decision about whether a drug prescribed for you will be covered by us and the amount you'll need to pay, if any. If a drug is not covered or there are restrictions or limits on a drug, you may request a coverage determination.

A group health plan's prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. Prescription drug coverage that does not meet this standard is called “non-creditable.”

National Coverage Determinations (NCDs) are developed by the Centers for Medicare & Medicaid Services (CMS) and applied on a nationwide basis. NCDs generally describe the criteria and coverage limitations that apply to particular services, procedures or devices for coverage and payment purposes.

The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions.

A coverage decision is a decision we make about your benefits, coverage, or the amount we'll pay for your medical services or medicine. This decision is also called an organization determination when it is about a Part C medical benefit.

Please complete this form to indicate whether or not you had prescription drug coverage that met Medicare's Minimum Standards of Credible Coverage prior to your enrollment in your current Medicare plan.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232