Sterling Product Information/Prospective Policyholder Section

Product
Information

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	Contact Customer Service
	Plan Availability by State
	Sterling Option IV^®^SM Overview
	Sterling Option IV^SM Summary of Benefits
	Sterling Option IV^SM Enrollment Form
	PFFS: What You Need to Know
	Provider Terms and Conditions of Participation

M0010_S4802_8309
(Pending CMS Approval)

Utah - Sterling Option IV^SM Information

Sterling Plan:	Sterling Option IV^SM Availability:
Sterling Option IV^SM	Available In: Beaver, Box Elder, Cache, Davis, Garfield, Iron, Kane, Morgan, Piute, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, and Weber counties.

Sterling Option IV^SM Information:
Sterling Option IV^SM Overview Last Updated 11/07	Click to View
Sterling Option IV^SM Brochure Last Updated 12/07 Print Version - (pdf file - 170k):	Click to View
Sterling Care Coordination Brochure Last Updated 11/07 Print Version - (pdf file - 160k):	Click to View
Sterling Forever Fit Directory Last Updated 11/07	Click to View
Sterling Forever Fit Brochure Last Updated 11/07 Print Version - (pdf file - 160k):	Click to View
2008 Summary of Benefits Last Updated 11/07 Print Version - (pdf file - 2.2mb):	Click to View
2008 Evidence of Coverage Last Updated 01/08 Print Version - (pdf file - 1.2mb):	Click to View
PFFS: What You Need to Know Last Updated 11/07 Print Version - (pdf file - 70k):	Click to View
2008 Abridged Formulary Last Updated 09/08 Print Version - (pdf file - 1.7mb):	Click to View
2008 Comprehensive Formulary Last Updated 09/08 Print Version - (pdf file - 1.2mb):	Click to View
2008 Electronic Comprehensive Formulary Current version Last Updated 10/08 Print Version - (pdf file - 829kb):	Click to View
2008 Notice of Formulary Change
Release(1) NOC Last Updated 04/08 Print Version - (pdf file - 52kb):	Click to View
Release(2) NOC Last Updated 05/08 Print Version - (pdf file - 52kb):	Click to View
Release(3) NOC Last Updated 05/08 Print Version - (pdf file - 52kb):	Click to View
Release(4) NOC Last Updated 06/08 Print Version - (pdf file - 52kb):	Click to View
Release(5) NOC Last Updated 07/08 Print Version - (pdf file - 52kb):	Click to View
Release(6) NOC Last Updated 08/08 Print Version - (pdf file - 52kb):	Click to View
Release(7) NOC Last Updated 09/08 Print Version - (pdf file - 50kb):	Click to View
Low Income Subsidy Information
BAE	BAE (Best Available Evidence) Policy guidance link: Click Here
2008 LIS - Low Income Subsidy Premium Last Updated 08/08 Print Version - (pdf file - 66k):	Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs Chart.

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2008 Enroll with Medicare Enrollment Center

How This Works:

By clicking this button you will be leaving sterlingplans.com and will be connected to the Medicare enrollment center to your specific plan choice and will be passed to the Medicare Enrollment Center to start your application on https://enrollmentcenter.medicare.gov. Follow the instructions to complete your application. Once the application is completed and submitted you will be returned to sterlingplans.com.

Please enter your zip code and then click on "Enroll with Medicare" button to enroll for this specific plan.

Sterling Plan:	Available Benefits:
Formulary and Pharmacy Search Engine
Sterling Option IV^SM Last Updated 10/08	Part D Pharmacy Locator Click to View
Express Scripts - Sterling Prescription Online Ordering Benefits
Sterling Option IV^SM Last Updated 10/08	If you are a current Sterling Option IV^SM member, Click to View

Document Title:	Downloads:
Out-Of-Network Coverage Last Updated 11/12/2008	Click to View
Grievance Coverage and Appeals Procedures Last Updated 11/12/2008	Click to View
Quality Assurance Policy and Procedure Last Updated 11/12/2008	Click to View
Potential for Contract Termination Last Updated 11/12/2008	Click to View
Transition Policy Last Updated 11/12/2008	Click to View

Sterling Plan:	Enrollment Information:
Sterling Option IV^SM	Download Enrollment Application Instructions (50kb)
Sterling Option IV^SM	Download Enrollment Application Form

Be Sure To.....

a) Completely fill out the information on all pages of the Enrollment Application Form and initial statements where indicated.

b) On page 4, be sure to sign and date the Application. You'll need your Medicare Card to fill out the bottom portion on Page 1.
(Do not send in your Medicare Card, simply copy the information on the card to this page 1 of the Application.)

Enclose the following:

a) Completed four-page Enrollment Application Form.

b) First month's premium in the form of a check or money order made payable to Sterling.

c) Mail To:
ATTN: Enrollment Services
Sterling Life Insurance/SterlingPlans.com
PO Box 1917
Bellingham, WA 98227-9715

Once your completed Application and premium are received and processed, you will receive a Welcome Packet containing a wealth of information including a letter confirming your enrollment and its effective date as well as your Sterling Option IV^SM Identification Card.

2008 Medicare Advantage PFFS Disclaimer:

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare Supplement plan. Your doctor or hospital is not required to agree to accept the plan�s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan�s terms and conditions on our website at: www.Sterlingplans.com.

Questions?
For clarification on any of these steps, don't hesitate to call, 1-888-858-8572 or 1-888-858-8567 for TTY. Staff is available to assist you Monday through Friday, 5:00 a.m. to 5:00 p.m. Pacific time.

Click here for a listing of offices near you.

Last Updated: 10/2008

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