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Terms and Conditions
Iron Road is an HCPP Part B and a Medicare Part A & B Secondary plan, as well as a Part D
Prescription plan, administered by OptumRx, and has a contract with the Federal government. 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 plan, I have the right to appeal plan decisions about payment or services
if I disagree. I will read the Evidence of Coverage from Iron Road when I get it to know what
rules I must follow to get coverage with Iron Road’s Medicare plan. 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 plan, 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 plan coverage begins, I am required to get all of my healthcare via the Iron Road Medicare plan, and I must supply providers with a copy of my Iron Road Medicare plan ID card, along with my Medicare-Issued card. The services outlined in the Iron Road Evidence of Coverage (EOC) book will be covered. I also understand that certain services require prior authorization. Without authorization, neither Medicare nor Iron Road will cover those services.