Member Resources for 2024

Information and resources for Generations Advantage members.

Looking for 2023 Member Resources? Click Here. Current Generations Advantage members can review their Annual Notice of Change here.

Benefit Details Overview

Discover the full range of your health benefits, from dental to vision and prescriptions.

The Martin’s Point Generations Advantage dental benefit is administered by Northeast Delta Dental (NEDD).

To learn if your plan includes dental coverage, you may call Member Services at 1-866-544-7504 (TTY: 711). For details about your dental benefit, call the Northeast Delta Dental Customer Service Department at 1-800-832-5700 (TTY: 1-800-332-5905) Monday through Friday, 8 am–4:45 pm. 

Please note that, for most plans, there is up to a $50 copay for each office visit. Plan members also pay any additional cost shares. To learn more about specific dental coverage, visit our dental benefit pageNote: Coverage varies by plan.

To find out if your dentist participates in the NEDD Martin’s Point Generations Advantage dental network, please use the Delta Dental Dentist Search tool or contact NEDD directly.

The Generations Advantage extra hearing benefit covers hearing aids/batteries and is administered through our partner, Amplifon. Members who purchase hearing aid(s) through Amplifon receive an annual allowance to use toward the purchase. Amplifon will help you find a hearing aid provider near you, explain the process, help you schedule an appointment, and send information to you and the provider, ensuring your allowance amount is applied. Call Amplifon, 8 am–8 pm, Monday through Friday to get started: 1-888-669-2167 (TTY: 711) 

Learn more about your hearing aid benefit information. Note: Allowance amounts vary by plan.

MEDICARE-COVERED ORGINAL MEDICARE VISION BENEFITS

NON-ROUTINE EYE EXAM

  • Service Coverage: Covers non-routine outpatient physician services for eye diseases and injuries, including age-related macular degeneration.

  • Member Cost: $0-45 copay depending on your plan. See your Evidence of Coverage for plan specific details.

ANNUAL ROUTINE EYE EXAM

  • Coverage: This benefit includes a comprehensive eye exam to assess your need for eyeglasses or contacts, and may also cover diabetic eye exams and glaucoma screenings for high-risk individuals.

  • Frequency: Covered once per calendar year. This means you can have an exam once at any point in a year, from January through December. For example, if you have an exam in December, you're eligible for another exam as early as January the following year.

  • Member Cost: $0-45 copay depending on your plan. See your Evidence of Coverage for plan specific details.
   Note: This benefit covers the eye exam only and does not include eyewear.


MEDICARE-COVERED CONTACTS AND EYEGLASSES AFTER CATARACT SURGERY

POST CATARACT EYEWEAR

  • Coverage: Members pay 20% coinsurance of the Medicare-allowable rate for standard eyeglasses or contacts post-cataract surgery with intraocular lens insertion.

  • Reimbursement: To submit for reimbursement, use the Medical Services Reimbursement Form (PDF)Note: Reimbursement paperwork, including proof of payment, must be received within a year of the date of service.

MARTIN'S POINT GENERATIONS ADVANTAGE COVERED SUPPLEMENTAL EYEWEAR BENEFIT

EYEWEAR ALLOWANCE AND REIMBURSEMENT

  • Benefit Description: This benefit provides an annual eyewear allowance, which members can claim through our reimbursement process. Your plan reimburses up to an annual amount for prescription lenses, frames, and contact lenses for the purpose of correcting/improving a member’s vision. Amount varies by plan (See below).

  • NEW for 2024! ONLINE REIMBURSEMENT REQUEST: Try this new online reimbursement option for easier submission and quicker processing!

    SUBMIT ONLINE NOW

  • REQUEST BY MAIL: Use this new form for reimbursement for items eligible under your prescription eyewear benefit up to your plan's annual limit. (DO NOT use this form if your eyewear purchase is due to recent cataract surgery. In this case, use the Medical Services Reimbursement Form.)

2024 Member Reimbursement Form

To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025.

Annual Reimbursement Maximum: The reimbursement limit for eyewear varies based on your plan:

 

*For Access plan: $150 reimbursement in Belknap, Carroll, Coos, and Grafton Counties; $250 reimbursement in Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties.



This requirement encourages members to try less costly but usually just as effective ‘preferred’ drugs before the plan covers another ‘preferred’ drug. For example, if Drug A (preferred) and Drug B (non-preferred) treat the same medical condition, the plan may require you to try Drug A first. If Drug A does not work for the member, the plan will then cover Drug B.

Step therapy is not required for members who have used a non-preferred drug within the last 365 days, but authorization is required. To see list of preferred and non-preferred step therapy drugs please see our 2024 Part B Therapy Drug List (PDF).

All Generations Advantage plans have OTC benefits with Over-the-Counter Health Solutions (OTCHS) by CVS Caremark.

Members receive a quarterly amount to purchase from over 350 CVS-brand, over-the-counter products. Quarterly amounts do not roll over to the next quarter. Available items include these and more:

  • Smoking cessation: Nicotine replacement patches
  • Oral health: Toothpaste, toothbrushes, floss
  • Pain relief: Ibuprofen, acetaminophen
  • Allergy: Allergy relief tablets
  • Cold remedies: Cough drops, daytime/nighttime cold medicine
  • Digestive health: Heartburn relief tablets, daily fiber
  • First aid: Bandages
  • Incontinence: Bladder control products

Download the 2024 catalog (PDF)

*Quarterly amounts varies by county. Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan counties in New Hampshire $25/quarterly, all others $50/quarter.

You may make a purchase in person at participating CVS locations, over the phone by calling OTC Health Solutions at 1-888-628-2770 (TTY: 711), or search and buy products online.  

Your flexible Wellness Wallet benefit reimburses up to your plan’s annual amount for a wide range of eligible gear, fees, and services that help keep you active and well.  

To be eligible for payment, the date of service or purchase must be while you were enrolled in a 2024 Generations Advantage plan and you must submit your claim by March 31, 2025. To see a list of items/services eligible for reimbursement, visit the Wellness Wallet benefit page. If you are not sure whether your expense is eligible for reimbursement, please call Martin's Point Generations Advantage Member Services at 1-866-544-7504 (TTY: 711) or see the Wellness Wallet FAQs for details.

NEW for 2024! ONLINE REIMBURSEMENT REQUEST: Try this new online reimbursement option for easier submission and quicker processing!

SUBMIT ONLINE NOW

Reimbursable Amounts by Plan

Your Wellness Wallet reimburses up to your plan’s annual amount for covered items/services. Reimbursement amounts by plan are as follows:

 

OVERVIEW

Your free* annual flu shots can be administered at participating pharmacies** as well as by your primary care provider. Shots covered include quadrivalent, trivalent, trivalent (high dose), and intradermal.

  • In-Network Pharmacy: Free at participating pharmacies including Hannaford, Rite Aid, CVS (including former Target pharmacies), Shaw’s/Osco, Walgreens, and Walmart.
  • PCP/Doctor's Office: If you get the shot at your primary care provider’s office, you may have to pay a copayment for the office visit depending on your plan, but there will be no cost for the flu shot.
  • Out-of-Network Pharmacy: If you get your flu shot at a pharmacy that is not in the Vaccine Pharmacy Network, it may still be covered by your plan. You will pay the full cost at the pharmacy and submit a form to us for reimbursement.

If you don’t show your Generations Advantage member ID card when you get your flu shot, you will pay the full cost at the pharmacy and submit a form to us for reimbursement.

Flu Shot Reimbursement Form (PDF)

If your pharmacist has problems sending your claim to us, they should call our Part D Pharmacy Help Desk at 1-800-364-6331

*Influenza (flu) vaccines are covered under your Medicare Part B benefit through your Generations Advantage plan.

**The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.

OVERVIEW

Colorectal cancer screenings save lives. All screenings have a $0 copay when you go to an in-network provider. Ask your primary care provider which screening and schedule is right for you. We cover these screenings more frequently for people at high risk for colorectal cancer.

Documents and Forms

Access key documents and forms, including coverage details and reimbursement forms.

For any plan-specific documents, please see your individual 2024 plan page below.

Prime (HMO-POS) 

Alliance (HMO)

Value Plus (HMO-POS)

Select (LPPO)

Access (LPPO)

The Evidence of Coverage document outlines your Medicare health benefits, services, and prescription drug coverage as a member of Martin's Point Generations Advantage. This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2024. It explains how to get coverage for the health care services and prescription drugs you need.

PRIME (HMO-POS)

H5591-015-001 - Lincoln, Oxford, Piscataquis, Somerset, Waldo Counties in Maine. For Belknap, Carroll, Coos and Grafton Counties in New Hampshire (PDF)

H5591-015-002 - Aroostook, Franklin, Hancock, Knox, Penobscot and Washington Counties in Maine (PDF)

H5591-005 - Cheshire, Hillsborough, Merrimack, Rockingham, Strafford and Sullivan Counties in New Hampshire (PDF)

H5591-006-001 - Cumberland County in Maine (PDF)

H5591-006-002 - Kennebec and Sagadahoc Counties in Maine (PDF)

H5591-006-004 - York County in Maine (PDF)

H5591-006-005 - Androscoggin County in Maine (PDF)


ALLIANCE (HMO)

H5591-003 - For All Counties in Maine and New Hampshire (PDF)


VALUE PLUS (HMO-POS)

H5591-009 - Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo and Washington Counties in Maine (PDF)

H5591-013 - Kennebec and Sagadahoc Counties in Maine (PDF)


SELECT (LPPO)

H1365-001 - Androscoggin, Aroostook, Cumberland, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, Washington and York Counties in Maine, and Cheshire, Coos, Hillsborough, Merrimack, Rockingham, Strafford and Sullivan Counties in New Hampshire (PDF)


ACCESS (LPPO)

H1365-004-002 - Belknap, Carroll, Coos, and Grafton counties Counties in New Hampshire (PDF)

H1365-004-003 - Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties in New Hampshire (PDF)

This is a summary of drug and health services covered under your Martin's Point Generations Advantage plan.

Summary of Benefits Prime (HMO-POS), Select (LPPO), Access (LPPO), Value Plus (HMO), and Alliance (HMO) (PDF)

REIMBURSEMENT REQUEST FORMS

NEW for 2024: We’ve created a new, combined form—“2024 Member Reimbursement Form—Wellness Wallet/Eyewear.” This form should be used when submitting a request by mail for reimbursement for items under your 2024 Wellness Wallet benefit and items under your separate prescription eyewear benefit (not related to cataract surgery). See details below!


WELLNESS WALLET REIMBURSEMENT REQUEST

NEW FOR 2024!  ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing! Submit your Wellness Wallet reimbursement request online.

REQUEST BY MAIL: Use this form for items/services covered under your 2024 Wellness Wallet reimbursement benefit up to your plan’s annual limit. 

2024 Member Reimbursement Form Wellness Wallet/Eyewear

To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025. 

Learn more about this benefit on our Wellness Wallet Benefit page.



EYEWEAR REIMBURSEMENT REQUEST

NEW FOR 2024!  ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing! Submit your Prescription Eyewear reimbursement request online

REQUEST BY MAIL: Use this form for reimbursement for items eligible under your prescription eyewear benefit up to your plan's annual limit. (DO NOT use this form if your eyewear purchase is due to recent cataract surgery. In this case, use the Medical Services Reimbursement Form seen below.)

2024 Member Reimbursement Form Wellness Wallet/Eyewear

To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025.

Learn more about this benefit on our Vision Benefits page.



MEDICAL SERVICES REIMBURSEMENT REQUEST

This form is for reimbursement for covered medical services that you received through a provider or at a medical facility. This also includes eyewear that you purchased due to recent cataract surgery.

Medical Services Reimbursement Form (PDF)

Learn more about this benefit on our Contact and Eyeglasses After Cataract Surgery page.



PRESCRIPTION DRUG REIMBURSEMENT REQUEST

Use this form when you have paid out-of-pocket for your Part D formulary prescription drug. DO NOT use any other forms if your reimbursement request is for prescription drugs. 

Prescription Drug Reimbursement Form (PDF) 


Automatic Payment Options Form (PDF)
Use this form to sign up for automatic payment of your monthly plan premium.

Authorization to Release Information (PDF)
Use this form to authorize a designated representative to discuss certain aspects of your health care.

Continuity of Care Form (PDF)
Use this form to request a 90-day Continuity of Care period to ensure your ongoing care remains uninterrupted.

Medicare Appointment of Representative (PDF)
Use this form to appoint a representative who can assist with all Medicare-related inquiries.

Members Rights and Responsibilities Statement (PDF)
This document provides the Martin's Point Health Plan Member Rights and Responsibilities statement.

Multi-language Interpreter Services (PDF)
This document provides information for multi-language interpreter services.

Part D Senior Savings Model Eligible Insulin Drugs (PDF)
This is a list of the Part D Senior Savings Model for eligible insulin drugs.

Preventive Care Checklist (PDF)
Use this form to track your recommended preventive care and bring it with you to your next primary care visit.

Provider Attestation for Supplemental Benefits Form (PDF)
Use this form to receive supplemental benefits for specific diagnosis.

Request for Medicare Prescription Drug Coverage Determination (PDF)
Use this form to request coverage for a drug that isn’t covered or has restrictions.

Request for Redetermination of Medicare Prescription Drug Denial (PDF)
Use this form to request to appeal a denied prescription coverage.

Residence Address Verification Form (PDF)
Use this form to verify your residence address.

Waiver of Liability (PDF)
Use this form to waive any right to collect payment for services for which payment has been denied.

Veterans Affairs Record Release form (PDF) 
Use this form to authorize the Department of Veterans Affairs to release specific health information to designated individuals or organizations.

 

Health and Wellness Programs

Explore programs for nutrition, emergency response, and personalized care management

OVERVIEW

Martin’s Point Health Care has teamed up with Foodsmart™ to provide you with free, unlimited chats with a nutrition coach—plus much more—to support healthy eating from the comfort of home by telephone or online.

You don’t need to use your health plan’s Wellness Wallet reimbursement program to take advantage of this benefit as your Generations Advantage plan covers 100% of the program cost.

The Foodsmart program is tailored to your individual needs and preferences—from nutrition tips for managing a medical condition, to simply wanting to eat healthier, or just trying to save on groceries. Your Foodsmart nutrition coach and other resources can make healthy eating easier and more affordable.

To get started, call 1-888-837-5325 to schedule an appointment with a nutrition coach.

If you prefer to reach out online, you can:

  • Download the Foodsmart app in the App Store or Google Play. Click on “Sign Up.” Your Group is “Martin’s Point Generations Advantage.”

Martin’s Point care management programs are entirely voluntary. You can choose not to participate or to stop participating in the program at any time. If you have immediate concerns regarding your health, please contact your doctor. Always consult your health care provider before making any lifestyle changes. Only your doctor can diagnose and treat a medical condition.

Generations Advantage plan members receive discounts for medical alert devices through LifeStation. Please note, this is not a plan benefit and is instead a value-added discount.

This discount results in members receiving up to a ~25% discount off of regular consumer pricing, with discounted monthly costs ranging from $19.95 to $36.95, depending on the unit chosen.

LifeStation details:

  • Choose an in-home system (landline or cellular that can be used only in the home), LifeStation Smartwatch, or a mobile system with location services which can be used outside of the home
  • Fall-detection option available for an additional fee (automatically alerts LifeStation that you have fallen, even if you do not press the emergency button)
  • Product warranty on all service plans (a $5 per month value at no charge)
  • Spousal coverage available on all in-home units (a $3.99 per month value at no charge)
  • Additional cost for a device protection plan may apply

Members have the option to purchase nutritionally balanced, refrigerated, and ready-to-eat meals that are delivered by Mom’s Meals direct to your home. 

  • Martin’s Point Generations Advantage members will get free shipping on all orders (a savings of $14.95).
  • Menus are designed by chefs and registered dietitians to support general wellness goals or the specific nutrition needs of common health conditions.
  • Members can select every meal, every order from over 70 entrée options.
  • Entrées are refrigerated and ready-to-eat after just two minutes in the microwave.

Place your order online or by phone using code MPGA to activate the offer:

Online: momsmeals.com/mpga
Phone: 1-877-347-3438

 
OVERVIEW

As a Martin’s Point Generations Advantage member, you are eligible to receive FREE, personalized care management. Sign up for a dedicated medical or behavioral health care manager who will help you succeed at leading a healthy, active, and full life.

Our care managers can help you:

  • Manage your health care
  • Navigate your health plan
  • Understand medications
  • Find community support and resources

We want to help you live the healthiest life possible. Get started by calling a Martin’s Point care manager at 1-877-659-2403 or visit our Health Services page for more details.

Martin’s Point care management programs are entirely voluntary. You can choose not to participate or to stop participating in the program at any time. If you have immediate concerns regarding your health, please contact your doctor. Always consult your health care provider before making any lifestyle changes. Only your doctor can diagnose and treat a medical condition.

Comprehensive Services, Support, and Insights

Find payment options to state resources, 24/7 nurse support, and deepen your understanding with 'The Advantage' newsletter and our Medical Care Criteria Overview.

PAY YOUR GENERATIONS ADVANTAGE PLAN PREMIUM ONLINE!

One-Time Payment

It's easy to make a one-time credit card payment. Just click the button below and use the PayTrace service to make your secure credit card payment.



Recurring Monthly Payments

To set up secure, recurring payments, please call Member Services or mail us a completed and signed Automatic Payment Form.


MEDICAL CARE CRITERIA OVERVIEW

Empower Your Healthcare Decisions:

Gain insight into how we determine the medical necessity for treatments and services, ensuring you receive care that meets established medical standards. This knowledge supports your healthcare journey with us, aligning with Medicare's guidelines. 

MPHC MEDICAL NECESSITY CRITERIA

These guidelines apply to both Generations Advantage and US Family Health Plan benefits. View PDF.

TRICARE® MANUALS

All TRICARE Program Manuals are available on the Military Health System and Defense Health Agency website: View here.

eviCore® IMAGING GUIDELINES

The eviCore Clinical Guidelines and Resources/End User Agreement is available here: View eviCore.com.

MEDICARE BENEFIT POLICY MANUAL

These guidelines are available on the Centers for Medicare & Medicaid Services website: View Policy Manual.

MCG GUIDELINES

Documents referring to our Medical Care Guidelines—you must be logged in to see this content: Log in to view.

OPTUM POLICIES

Radiation Oncology and Specialty Pharmacy policy information—you must be logged in to see this content: Log in to view.

Social Security
1-800-772-1213
(TTY/TDD: 1-800-325-0778)

Medicare
1-800-MEDICARE (1-800-633-4227)
(TTY/TDD: 1-877-486-2048)
24 hours a day, 7 days a week

Maine State Health Insurance Assistance Program
1-800-262-2232
(TTY/TDD: 1-800-606-0215)

Maine Low Cost Drugs for the Elderly or Disabled Program (DEL) and Maine Rx Plus
1-866-796-2463
(TTY/TDD: 1-800-423-4331)

MaineCare (Medicaid)
207-287-2674
(TTY/TDD: 711)

New Hampshire Medicaid
1-800-852-3345 ext 4344 or
603-271-4344

New Hampshire ServiceLink Resource Center Network
1-866-634-9412

New Hampshire Medication Bridge Program
603-225-0900
 

At Martin’s Point, we are committed to providing our members a fair and timely process for resolving any complaints or disputes. We encourage Martin’s Point Generations Advantage members to contact us with questions, concerns, or problems related to any benefits or service.

Please call us at 1-866-544-7504 (TTY: 711), 8 am to 8 pm, seven days a week from October 1–March 31, and Monday through Friday the rest of the year, to discuss your concerns.

OVERVIEW

Talk with a trained nurse anytime, 24 hours a day, 7 days a week, to answer any questions about symptoms, injuries, or illness. 

Call 1-800-530-1021 if you need to know:

  • If a cut requires stitches
  • If you should head to an urgent care clinic, the ER, or wait until morning to see your doctor
  • General information about a condition, medication, or other health concerns

This service is provided by Carenet Health in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.

Online Account
See your claims, make secure requests, and more.
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Have questions? We’re here to help.

Representatives are available daily from 8AM-8PM from October to March 31, and on weekdays only during the remainder of the year.

Current Members:
1-866-544-7504 (TTY:711)