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FOX INSURANCE COMPANY MEDICARE PRESCRIPTION DRUG PLAN INDIVIDUAL ENROLLMENT FORM laptop battery

Any information you submit to us online for processing your enrollment is encrypted, using the latest 128-bit SSL encryption technology provided by VeriSign. We know that Security is a primary concern of our online beneficiaries. That's why we have registered our secure Web site with VeriSign. VeriSign helps to ensure the authenticity of our Web site. At any time within our site, we encourage you to "click" on the VeriSign icon shown in each of the pages. thinkpad

To enroll in Fox Rx Care, Please Provide The following Information: Select State: Select Your State ME NH NJ NC FL AR IA MN MT ND NE SD WY CO AZ OR WA HI Agent #: Fox Rx Care Grand Plan $30.00 per month Fox Rx Care Value Plan $26.00 per month Fox Rx Care Value Plan $24.00 per month Fox Rx Care Value Plan $21.00 per month Fox Rx Care Value Plan $22.50 per month Select Title Mr. Mrs. Ms. Sex: M F Last name: * First name: * Middle name: Date of Birth: * Social Security Number: Home Phone Number: * - - - - - - Permanent Residence Address1: * Address2: City: * State: * Select Your State ME NH NJ NC FL AR IA MN MT ND NE SD WY CO AZ OR WA HI ZIP Code: - Mailing Address: Same As Permanent Residence Address Address1: City: State: Select State AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NY NV OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY E-mail Address: Emergency contact Emergency contact: Phone Number: - - Relationship to You: Please Provide Your Medicare Insurance Information Please check which plan you want to enroll in: Please take out your Medicare Card to complete this section. Medicare Health Insurance SAMPLE ONLY Name * Medicare Claim Number * - - - Sex Select Sex Male Female Is Entitled To Effective Date HOSPITAL (PART A) - - HOSPITAL (PART B) - - Please fill in these blanks so they match your red, white and blue Medicare card .

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10/23/2007 New Enrollment Period begins for eligible beneficiaries. 10/03/2007 Personal Emergency Response Systems available for all members! Choose Cities Region 1 :  ME , NH Current Members For Providers Privacy Statement FAQ Glossary

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Step 1 images When you need assistance, simply press the HELP button worn around your neck, which will send a signal to us via your phone console. Step 2 A trained representative will speak to you upon receiving your signal, and stay with you till the emergency situation has been handled. If we cannot hear you, we will call your emergency #s on file. Step 3 Whether its calling your personal contacts, ambulance, fire, or police, Life911Plus^TM will work with you to make sure you are safe. In an event of hospitalization, we will alert your personal contacts, so that your loved ones are kept informed. Click here... For information about the Life911Plus^TM Product, click here Click here... For Pricing and Enrolling in Life911Plus^TM service, click here For More Information about this service, please call Life911Plus^TM at 1-877-TEND-911, or 1-877-8363-911. Please mention that you are a Fox Insurance member, and allow their friendly representatives to walk you through the process. FoxRx Care 2007-2008 | Privacy Policy | Terms of Use Page Modified: 10/23/2007 | CMS Approval Date: 11/02/2007

skype_tb_injection In 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 staticinactive_a 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 static skype_tb_injection In 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 staticinactive_a 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 static skype_tb_injection In 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 staticinactive_a 1 Temp__Skype IEToolbar_Cache 847 a 8 f 5723 cfca 6 b 3 fd 9946506 static Zoom in Zoom out about Us Fox Team our Mission health Plans enroll Now Support Order Prescriptions Welcome to the Fox Rx Care Mail Order Pharmacy! 2008 You can order your prescriptions online and have them delivered to your from your home or office. Envision is the new Prescription Benefit Manager for Fox Rx Care, The mail service program is ideal when your doctor gives you a prescription for a long term or maintenance medicine. Click here to begin your mail order prescription process. http://www.costco.com/Common/Category.aspx cat=678&eCat=BC|678 Choose Cities Region 1 :  ME , NH Region 4 :  NJ Pharmacy_Locator Zoom in Zoom out about Us Fox Team our Mission health Plans enroll Now Support Pharmacy Locator

Whether you are in your home town or on vacation somewhere else in the nation, you want to feel confident that you can quickly fill a prescription. We have partnered with pharmacies located throughout the nation. To find a participating retail pharmacy, simply enter a location using either a valid zip code or a city, state abbreviation (example: Phoenix, AZ). When entering the city and state, please be sure to include a comma between the city name and the state abbreviation. lenovo

Rupa Sinha ICWA She is a Cost Accountant. She has passed her ICWA in Dec 2006 and has worked in an Audit Firm as Team. Sujit Kumar nayak He is a Cost Accountant. He has completed it in the year 2006. He has experience in Excise control, Service Tax, Sales Tax and Capital Budgeting Decision-making and also handling General Insurance Business independently. Kamal Kejriwal CA & ICWA He is a CA & ICWA. He has 12 months of work experience in Accounting and Finance management. He likes to play Chess & Cricket and also likes to read finance journals. Anand K Accountant He takes care of CF accounts and payroll of the employees and will be doing budgets. He is BSc in Mathematics, MCom, MBA Finance and is studying CWA. He is with the company from Jan 2008. Surya Panwar Assistant Compliance Officer Compliance & Reporting. A qualified lawyer with over 2.5 years of experience in Legal Documentation, Drafting & Pleading before Courts & Forums. Enrolled with the Bar Council of Jaipur, India since 2004. Surya has wide experience in the field of Banking, Financing, Insurance and Medical law. Ashish Kumar Assistant Legal & Compliance Officer He has completed Bachelor of Laws (LL.B) in the year 2006 and has also done Diploma in Criminology (D.C.L.) in 2007. He has practiced as an Advocate in Rajasthan High Court for a year. Pallavi Jain She has completed LLB (2004), Diploma in Taxation (2005) and LLM (2007). She has practiced as an advocate for 3 years in Rajasthan High Court. Dominic Pereira Team Lead An in-depth understanding of the process and the functionality of the tools involved. Ensure services are delivered in accordance with the agreed SLAs and TAT. Creation of Process maps, Flash presentations, Standard scripts & FAQs. Be a subject matter expert on process & service and be a single point of contact for day-to-day issues. Improve & standardize contact center processes. Provide support to team members Infrastructural & Technical. Identify training needs to handle new processes & migrations for the team & ensure they are trained accordingly. Sharing process updates with team. A graduate in Commerce from Loyola College. About 7yrs experience in the field of ITES. John R Meyn Critical Customer Executive (PERS) Handling all emergency calls. Responsible for entering data into the CRM, ensuring the chat & tickets raised are replied with in the agreed SLA. Around twenty two years experience in the fields of Marketing & ITES. Poonam Kumar Handling all emergency calls. Ensuring the daily reports is delivered as per SLA. Maintenance of monthly test calls and daily call logs. Pursuing a bachelor degree in Business Administration. One year & six months of experience in the field of ITES. Glen Leonard Handling all emergency calls. Creation of call scripts & FAQs. Maintenance of database. Subject matter expert for hardware support (Panel & Pendant) Training for all new joiners in regards to the hardware support. Diploma in Printing Technology Around 20yrs of experience in the fields Printing, Hospitality & ITES. Bruno Lewis Handling all emergency calls. Staffing & Maintenance of Attendance. Responsible for collection of monthly fee from the clients. Ensuring the chat & tickets raised are replied with in the agreed SLA. Diploma in Printing Technology. Around 15 plus yrs of experience in the fields Printing, Hospitality & ITES. Clinton Manuel Senior Critical Customer Executive (PERS) Handling all emergency calls. Responsible for all Billing & Technical related queries. Subject matter expert for the CRM (Microkey) Database maintenance and generating reports in the CRM (Microkey). Training for all new joiners in regards to the hardware support. A graduate in Commerce from the University of Madras. About 9 yrs of work experience in the fields of retail & ITES. Zoom in Zoom out about Us Fox Team our Mission health Plans enroll Now Support General Information You have choices in your Medicare Prescription Drug Coverage. As a Medicare beneficiary, you can choose from different Medicare prescription drug coverage options. One option is to get prescription drug coverage through a Medicare Prescription Drug Plan, like Fox Rx Care. Another option is to get your prescription drug coverage through a Medicare Advantage Plan that offers prescription drug coverage. You make the choice. Who is eligible to join You can join Fox Rx Care Plans if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and live in the service area. Eligible individuals may only enroll in one Medicare Prescription Drug Plan at a time and may not be enrolled in a Medicare Advantage Plan (HMO, PPO), unless they are a member of Medicare Private-Fee-For-Services plan that does not offer Medicare prescription drug coverage or are enrolled in an 1876 Cost Plan. You may join a Medicare Prescription Drug Plan during certain times of the year. How can I get help with drug plan costs Medicare beneficiaries with low or limited income and resources may qualify for additional assistance. If you qualify, your Medicare prescription drug plan costs, the amount of your premium and your drug costs at the pharmacy will be less. Once you have enrolled in Fox Rx Care, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-Medicare to see if you might qualify. Where can I get my prescriptions Fox Rx Care has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. The Fox Rx Care plan you choose may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. Does Fox Rx Care cover Medicare Part B or Part D Drugs Fox Rx Care Plans do not cover drugs that are covered under Medicare Part B as prescribed and dispensed. Generally, we only cover drugs, vaccines, biologicals and medical supplies that are covered under the Medicare Prescription Drug Benefit (Part D) and that are on our formulary. Does Fox Rx Care have a prescription drug formulary Fox Rx Care uses a formulary. A formulary is a preferred list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If the formulary changes, affected enrollees will be notified, in writing before the change is made. What is a Medication Therapy Management (MTM) Program A Medication Therapy Management (MTM) Program is a service that Fox Rx Care may offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. If you have questions concerning our MTM Program please contact the Fox Rx Care Customer Service team at 1-888-Fox-RxRx (1-888-369-7979)/ 1-888-369-7373. TTY/TTD callers should use 1-866-369-7373. We’ll be happy to answer your questions. What should I do if I have other insurance in addition to Medicare If you have a Medigap (Medicare Supplement) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan. If you decide to keep your current Medigap supplement policy, your Medigap Issuer will remove the prescription drug coverage portion of your policy and adjust your premium. Under certain circumstances, you can also buy a different Medigap policy without prescription drug coverage sold by your Medigap Issuer. Your Medigap Issuer cannot charge you more, based on any past or present health problems. Call your Medigap Issuer for details. If you or your spouse has, or is able to get, employer group coverage, you should talk to your employer to find out how your benefits will be affected if you join Fox Rx Care. Get this information before you decide to enroll in this plan. What are my protections in this plan All Medicare Prescription Drug Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area. TERM DEFINITION A "TIERs is a specific list of drugs. Your plan may have several tiers, and your copayment amount depends on which tier your drug is listed. Plans can choose their own tiers, so members should refer to their benefit booklet or contact the plan for more information. ACCESS Your ability to get needed medical care and services. ACCESSIBILITY OF SERVICES Your ability to get medical care and services when you need them. ACCESSORY DWELLING UNIT (ADU) A separate housing arrangement within a single-family home. The ADU is a complete living unit and includes a private kitchen and bath. ACT/LAW/STATUTE monebaggasse