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Terms and Conditions
Iron Road is an Employer Group Medicare Advantage Plan administered by United Healthcare and a
Part D Prescription plan, administered by OptumRx. I will need to keep my Medicare Part A and B.
I can only be in one Medicare plan at a time and I understand that my enrollment in this plan
will
automatically end my enrollment in another Medicare health plan. Enrollment in this plan is
generally
for the entire calendar year. Once I enroll, I may leave this plan or make changes only at
certain times
of the year if an enrollment period is available, or under certain special circumstances. Once I
am a member
of the Iron Road Medicare plans, I will read the Evidence of Coverage from United Healthcare and
OptumRx.
I must follow the rules to get coverage with Iron Road’s Medicare plans.
I understand that people with Medicare aren’t usually covered under Medicare while out of the
country except for
limited coverage near the U.S. border.
Release of Information. By joining this Medicare plans, I acknowledge that Iron Road will
release my information to
Medicare and other plans as is necessary for treatment, payment and health care operations.
I also acknowledge that Iron Road will release my information to Medicare, who may release it
for research and other
purposes which follow all applicable Federal statutes and
regulations. The information on this enrollment form is correct to the best of my knowledge.
I understand that if I intentionally provide false information on this form, I will be
dis-enrolled from the plan.
I understand that beginning on the date the Iron Road Medicare plans coverage begins, I am
required to get all of
my healthcare via the Iron Road Medicare plans, and I must supply providers
with a copy of my Iron Road Medicare plans ID cards.