Granite Alliance Member's Rights

As a member of Granite Alliance you have the right to:

Be treated with respect and recognition of your dignity and have the right to privacy

Receive a listing of all Granite Alliance participating pharmacies

Submit a question or complaint to Granite Alliance, without fear of discrimination or repercussion

Receive information on plan related policies and procedures

Receive timely responses to your requests regarding your prescription drug coverage

For more details about your rights, please review Chapter 5 of your Evidence of Coverage.

Alternative Formats

We must provide information in a way that works for you (in languages other than English, braille, large print, or other alternative formats). Granite Alliance offers free language interpreter services to answer questions, and we will also provide information to you in alternative formats at no cost. To get information from us in a way that works for you, please contact our Member Services and we'd be happy to assist you.

We treat you with fairness and respect at all times!

Granite Alliance must obey laws that protect you from discrimination or unfair treatment. We do not discriminate based on a person’s race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, or geographic location within the service area.

Get timely access to your covered drugs

You have the right to get your prescriptions filled or refilled at any of the network pharmacies without long delays. If you think that you are not getting your covered drugs within a reasonable amount of time, you can contact Granite Alliance Member Services for personal help.

Protect your Personal Health Information

Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.

Your personal health information includes the personal information you gave us when you enrolled in this plan as well as your medical records and other medical and health information.
The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We give you a written notice, called a Notice of Privacy Practice, which tells about these rights and explains how we protect the privacy of your health information.

How do we protect the privacy of your health information?

We make sure that unauthorized people don’t see or change your records.
In most situations, if we give your health information to anyone who isn’t providing your care or paying for your care, we are required to get written permission from you first. Written permission can be given by you or by someone you have given legal power to make decisions for you.
There are certain exceptions that do not require us to get your written permission first. These exceptions are allowed or required by law.
- For example, we are required to release health information to government agencies that are checking on quality of care.
- Because you are a participant of a Medicare prescription drug plan, we are required to give Medicare your health information including information about your Part D prescription drugs. If Medicare releases your information for research or other uses, this will be done according to federal statutes and regulations,

You can see the information in your records and how it has been shared with others

You have the right to look at your medical records held at Granite Alliance, and to get a copy of your records. We are allowed to charge you a fee for making copies. You also have the right to ask us to make additions or corrections to your medical records. If you ask us to do this, we will work with your healthcare provider to decide whether the changes should be made. You have the right to know how your health information has been shared with others for any purposes that are not routine.

You have the right to get information

You have the right to get several kinds of information from us. If you want any of the following kinds of information, please call Granite Alliance Member Services.

Information about Granite Alliance. This includes, for example, information about the number of appeals made by participants and Granite Alliance’s performance ratings, including how it has been rated by plan participants and how it compares to other Medicare prescription drug plans.
Information about Granite Alliance network pharmacies. For example, you have the right to get information from us about the pharmacies in our network.
Information about your coverage and the rules you must follow when using your coverage. To get the details on your Part D prescription drug coverage, read this booklet. If you have questions about the rules or restrictions, please call Granite Alliance Member Services.
Information about why something is not covered and what you can do about it.
- If a Part D drug is not covered for you, or if your coverage is restricted in some way, you can ask us for a written explanation. You have the right to this explanation even if you received the drug from an out-of-network pharmacy.
- If you are not happy or if you disagree with a decision we make about what Part D drug is covered for you, you have the right to ask us to change the decision. You can ask us to change the decision by making an appeal.
- You can ask for reimbursement.
- You have the right to make complaints.

What if I feel I'm being unfairly or my rights aren't respected?

If you believe you have been treated unfairly or your rights have not been respected due to your race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin, you should call the Department of Health and Human Services’ Office for Civil Rights at 800-368-1019 or TTY 800-537-7697, or call your local Office for Civil Rights.

If you believe you have been treated unfairly or your rights have not been respected, and it’s not about discrimination, you can get help dealing with the problem you are having by calling:

Granite Alliance Member Services
Your State Health Insurance Assistance Program
Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY users should call 877-486-2048.

Granite Alliance Member's Responsibilities

As a member of Granite Alliance you also have responsibilities:

Be familiar with your covered drugs and the rules you must follow to get these covered drugs.

If you have any other prescription drug coverage in addition to Granite Alliance, you are required to tell us.

Tell your pharmacist to bill Granite Alliance.

Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.

Pay what you owe.

Tell us if you move.

For more details about your Responsibilities, please review Chapter 5 of your Evidence of Coverage.

Enrollment and Eligibility

Granite Alliance is an Employer Group Waiver Plan, which means you will be enrolled in the coverage directly by your employer. Generally you qualify for Granite Alliance benefits once you have retired. In addition, you also must have Medicare Part A or Part B in order to qualify for the Medicare Part D benefits through Granite Alliance.

For more information about enrolling into Granite Alliance, please contact your employer directly. You can also review Chapter 7 of the Evidence of Coverage for information about Medicare Part D eligibility requirements.

If you are already enrolled, and no longer wish to be covered by Granite Alliance, you may voluntarily end your plan enrollment. Since Granite Alliance is offered by your employer, you may lose other benefits (such as medical) if you choose to disenroll. We recommend speaking directly with your employer for options before electing to disenroll.

There are only certain times of the year, or certain situations, when you may voluntarily end your membership in the prescription drug plan. You may end your membership during the Annual Enrollment Period which occurs every November 1 through November 30 or during a Special Enrollment Period. To find out if you are eligible for a Special Enrollment Period, please call Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY users call 877-486-2048.

In addition, there is the potential for Granite Alliance to terminate our contract with Medicare. Our plan is required to notify our members that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice.

Last Updated Date: 12/04/2024