Declared Emergency or Disaster
During the time of a declared emergency or disaster Vibra Health Plan, will make certain accommodations in order for our members to receive health plan services.
Policy Regarding Care During a Disaster
The Secretary of Health and Human Services has the right to exercise his or her waiver authority under Section 1135 of the Social Security Act if, in addition to a Presidential declaration of a disaster or emergency under the Stafford Act or National Emergencies Act, the Secretary declares a public health emergency under Section 319 of the Public Health Service Act. If an 1135 waiver is issued, CMS will identify all plan requirements and responsibilities. Detailed guidance and requirements for MA plans will be posted on the Department of Health and Human Services website, http://www.hhs.gov/ and the CMS website http://www.cms.gov/. Vibra Health Plan (VHP) will check these websites frequently during disasters and emergencies to determine when the public health emergency/disaster declaration has ended and normal operations may resume.
Under the Secretary’s Section 1135 waiver, CMS may authorize DME and A/B MAC’s to pay for Part C-covered services furnished to enrollees and seek reimbursement from VHP for those health care services, retrospectively.
In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, but absent, or prior to the issuance of, a Section 1135 waiver by the Secretary, VHP will:
- Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted, Medicare certified facilities;
- Waive in full, requirements for gatekeeper referrals where applicable;
- Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing; and
- Waive the 30-day notification requirements to enrollees as long as all the changes (such as the reduction of cost-sharing and waiving authorization) benefit the enrollee.
Typically, the source that declared the disaster will clarify when the disaster or emergency is over. If, however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if CMS has not indicated an end date to the disaster or emergency, VHP will resume normal operations 30 days from the initial declaration. If VHP is not able to resume normal operations after 30 days, VHP will notify CMS.
Finding Information On Emergency Declarations
If you live in an area that's been declared an emergency or disaster, the usual rules for your medical care may change for a short time. Affected areas are areas where one of these has happened:
- The President has declared it an emergency or disaster. Visit the Federal Emergency Management Agency (FEMA), or call 1-800-621-FEMA (1-800-621-3362) to see if your area is affected. TTY users should call 1-800-462-7585.
- A governor has declared it an emergency or disaster. Visit your state government's official website to find out if your area is affected. Pennsylvania Emergency Management Agency (PEMA)
- The Secretary of the Department of Health and Human Services (HHS) has declared a public health emergency. Visit the HHS Public Health Emergency website, or call 1-800-MEDICARE to find out if your area is affected
- Questions and Answers: Enrollment Issues for Weather Related Emergences and Major Disasters.
What To Do If An Emergency Is Declared In Your Area
Seeing your doctor in a disaster or emergency
If you are a Member of Vibra Health Plan (VHP) check this site for information or contact us by telephone at 1-844-388-8268 (TTY 711) to see what temporary changes are being made when our health plan services get disrupted during an emergency or disaster:
- VHP will allow you to see certain doctors or go to certain hospitals that accept Medicare patients, even if the doctor or hospital isn't in the VHP network and your health care need isn't an emergency. If you have problems using an out-of-network doctor or provider, contact VHP for help.
- VHP won't require you to follow the prior authorization rules for out-of-network services.
- If you usually pay more for out-of-network or out-of-area care, VHP will apply the in-network rate during the emergency or disaster period. If you go to an out-of-area or out-of-network provider and pay more for the service, save the receipt and ask VHP to give you a refund for the difference.
You should contact VHP as soon as possible to find out if there are other changes in plan rules and to find out when the emergency or disaster will be over.
Getting Your Prescriptions In a Disaster Or Emergency
If you are a Vibra Health Plan (VHP) member and your state has issued a warning of a potential emergency or disaster:
- If you're not able to go to your usual network pharmacy to replace your prescription drugs, contact VHP or MyPrime to find another network pharmacy nearby.
- Contact VHP or MyPrime if you had to leave your home without your drugs, or your drugs have been damaged or lost because of the emergency or disaster. They can help you find another network pharmacy.
- If you can't reasonably get to a network pharmacy, VHP or MyPrime can help you get drugs during an emergency or disaster at an out-of-network pharmacy. You may pay more for drugs you get at an out-of-network pharmacy.
Using in-network pharmacies
- You'll be able to move most prescriptions from one network pharmacy to another, and back to your regular pharmacy when the emergency or disaster ends. If you need help finding the closest network pharmacy, contact VHP or MyPrime.
- You'll need to tell the new pharmacy the name of your regular pharmacy and which drugs you need refilled.
Using out-of-network pharmacies
- Contact VHP or MyPrime for information about their out-of-network rules.
- When you buy your drugs at an out-of-network pharmacy, you'll probably have to pay full cost for the drugs at the time you fill your prescriptions.
- To get a refund from VHP, submit a paper claim. You won't get a refund for the out-of-network cost-sharing amount.
Additional (extended-day) supplies
If you think you won't be able to return home for a long time, you may want to get an extended-day supply (a 60- to 90-day supply) of your prescription drugs. Ask your VHP or MyPrime whether it offers extended-day supplies and which pharmacies you can use to get them.
Contact VHP for more information on getting prescription drugs during an emergency or disaster.
Paying your premium in a disaster or Emergency
If you're a Vibra Health Plan (VHP) Member:
- If you pay your VHP premium directly to the plan each month, you're still responsible for paying your premium on time.
- Generally, VHP does not change policies for payment of monthly premiums during an emergency or disaster. Contact VHP to discuss payment options during the disaster or emergency period. Your plans may disenroll you if you don't pay your premiums on time.
- Options might include: signing up for premium withholding from your Social Security check or paying the plan by electronic funds transfer through your bank.
- If your plan disenrolls you for not paying your monthly premiums, and you didn't pay on time because of the emergency or disaster, you may be able to ask Medicare to reconsider the decision and get your coverage back.
Getting dialysis in a disaster or emergency
Contact Vibra Health Plan 1-844-388-8268 (TTY 711) to determine if there are temporary changes being made for the disaster or emergency. Even though your ESRD Network can help you find facilities that give dialysis services, VHP may have other alternatives available with an ESRD facility in the area where you're staying temporarily.
Getting cancer treatments in a disaster or emergency
Contact Vibra Health Plan 1-844-388-8268 (TTY 711) to determine if there are temporary changes being made for the emergency or disaster.
Replacing a lost card in a disaster or emergency
If you are a Vibra Health Plan (VHP) Member contact VHP at 1-844-388-8268 (TTY 711) to replace a lost or damaged membership card. If you have registered for access to our Member portal, please sign in and request an ID card online.
Replacing lost or damaged equipment or supplies in a disaster or emergency
If you are a Vibra Health Plan (VHP) Member contact VHP at 1-844-388-8268 (TTY 711) to determine replacement of DME or supplies damaged or lost during the emergency or disaster.
What to do if an emergency is declared in the area you are visiting
Contact Vibra Health Plan at 1-844-388-8268 (TTY 711) for assistance.