Member Resources

At SOLIS, one thing we have in common is a desire to make a difference through personal service. We have assembled the resources on this page in an effort to help you better manage your health.

Member Resources
Do the right thing! Even when nobody is looking…Integrity begins with you!

This is the SOLIS Health Plans (HMO) Corporate Compliance motto and words all SOLIS associates live by. At SOLIS, we truly believe everyone makes a difference when they do the right thing. SOLIS is committed to ensuring the highest level of ethical behavior in all we do.

Compliance Program

The Corporate Compliance Program is composed of eight (8) elements. The following represents a brief description of each element:

  1. Written Policies, Procedures and Standards of Conduct.

    SOLIS has established a standardized method for the development, management and administration of policies and procedures and has a Code of Ethics and Standards of Conduct that demonstrates the organizations ethical attitude and emphasizes our commitment to compliance with all applicable Laws. SOLIS policies and procedures and Code of Ethics and Standards of Conduct are issued to all employees upon hire and upon request. Additional clarifications regarding compliance guidance are issued in various publications of SOLIS.

  2. Compliance Officer, Compliance Committee and High-level Oversight.

    SOLIS has a Compliance Officer, who serves as the Chair of the Compliance, Audit and Risk Committee. The Committee meets regularly throughout the year and additional information regarding these meetings or the Compliance Officer responsibilities are available upon request.

  3. Effective Training and Education.

    A comprehensive and structured compliance and fraud, waste and abuse training program are provided to SOLIS employees as part of new-hire onboarding and annual training. Training is also required for temporary staff consultants and our FDRs. Employees are required to complete this training within the first 30 days of new hire and annually thereafter. This training includes specific examples of what constitutes fraud, waste, abuse, and overpayment. Training verification is obtained through a signed and dated acknowledgement by the employee. All employees are required, as a condition of employment, to complete the annual training and acknowledge their ongoing duty to report suspected or confirmed violations of the Compliance Program or fraud and abuse issues to the Compliance Officer and other appropriate authorities.

  4. Effective Lines of Communication.

    SOLIS is committed to establishing and maintaining an environment which fosters effective communication throughout all levels of the organization. The Compliance Officer encourages effective communication by being available to all board members, officers, directors, managers, employees, first tier, downstream and related entities for the reporting of potential instances of fraud, abuse or other compliance related concerns. Compliance utilizes a variety of methods to encourage communication including, but not limited to, email, face-to-face and published hotline numbers.

  5. Well Publicized Disciplinary Standards.

    Employees are expected to abide by the standards and policies adopted by the organization and will enforce non-compliance with these standards and policies in a timely, fair, equitable, and consistent manner. Standards are described in the Code of Ethics and Standards of Conduct which includes expectations for reporting compliance violations and how to identify non-compliant or unethical behavior.

  6. Effective System for Routine Monitoring and Identification of Compliance Risks.

    To confirm compliance with Medicare regulations, sub-regulatory guidance, contractual agreements, and all applicable Federal and State laws, as well as internal policies and procedures to protect against Medicare Parts C & D program noncompliance and potential FWA, SOLIS has established routine monitoring and auditing activities. SOLIS may enter into contracts with FDRs to provide administrative or health care services for enrollees on behalf of the plan. However, SOLIS maintains the ultimate responsibility for fulfilling the terms and conditions of its contract with CMS, and for meeting the Medicare program requirements.

  7. Procedures and System for Prompt Response to Compliance Issues.

    SOLIS has established documented procedures and a system for promptly responding to compliance issues as they are raised, investigating potential compliance problems as identified in the course of self-evaluations and audits, correcting such problems promptly and thoroughly to reduce the potential for recurrence, and ensuring ongoing compliance with CMS requirements.

  8. Identification of Compliance Risk - Risk Assessment.

    SOLIS recognizes risk assessments are very important and form an integral part of plan management. As part of its commitment to risk aversion and remediation, SOLIS, after 1 year of operation, will perform a baseline assessment of major compliance and FWA risk areas through a risk assessment. Each operational area will be assessed for the types and levels of risks the area presents to the Medicare program and SOLIS.


If you have a concern related to compliance or ethics we encourage you to report it. Any person, including SOLIS members, provider or FDRs, may confidentially or anonymously report suspected or known issues of non-compliance or ethic violations by calling the Compliance Hotline toll-free at 833-896-3761. In addition, if you would like to receive a copy of the SOLIS Corporate Compliance Program Description you may send a written request to:


SOLIS Health Plans, Inc. (HMO)

Attention: Corporate Compliance Office

9250 NW 36TH Street, Suite 400

Doral, FL 33178


Please be sure your request includes your full name and the complete mailing address of where we should send the request material.

Fraud, Waste and Abuse
Help protect yourself from fraud!

Health care fraud, waste and abuse affects all of us. It impacts the quality of health care and results in higher medical and prescription costs. There are many different types of fraud, waste and abuse. It’s important to be able to identify these issues and know what to look for to protect yourself from identify theft and benefit fraud.


Be suspicious of:
  • People trying to sell you health care items or services door-to-door or over the phone.

  • People who offer money or gifts for health care services.

  • People offering you free gifts or services in exchange for your Medicare ID number or health plan ID number.

  • Shipments of medical supplies you didn’t order.

  • Providers who tell you the item or service isn’t usually covered, but they “know how to bill” so insurance will pay.

Remember, if it seems to good to be true, it probably is.

Below are some other things you should be aware of to protect yourself from fraud, waste and abuse.


Online theft of personal information
  • People may try to steal your personal or Medicare information online. They can harm you financially. They may also disrupt your healthcare benefits.

  • It’s not always easy to tell the difference between an important email about your benefits and an online scam. An email may say there’s a problem with your account. Or it may ask for updated information to continue your healthcare coverage. When in doubt, give us a call at the Member Services number on your Id card. Where here to help.

Telemarketing scams

Many legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identify. Medicare won’t call to ask for your bank account number, Social Security Number, Medicare ID number or health plan ID number and neither will SOLIS.


To protect yourself:

  • Hang up on recorded messages that ask you to verify your personal information.

  • Don’t press any keys or numbers when prompted – even if it’s to take your name off their list.

  • Never give your personal information to someone you don’t know.

  • Report suspicious numbers to the Federal Trade Commission.

Things you can do to protect yourself and your benefits against fraud:

  • Never give out your Social Security, Medicare ID number, health plan ID number or banking information to anyone you don’t know. You should only provide this information to people you know should have it.

  • Know who you’re sharing your personal information with.

  • When you receive a bill for services review it carefully.

    • Make sure you received the services or items.

    • Check the number of services or items on your bill or explanation of benefits.

    • Be sure the same service isn’t on your bill more than once.

    • Verify the copayment amount is correct.

  • If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Ask about the services you receive, such as: Why are they needed?

  • Or, your provider may realize a billing error was made.

  • Delete or ignore suspicious emails. Don’t click or download attachments you aren’t expecting. Legitimate email addresses usually end in .com, .org or .gov.

  • If you are unsure about information you have received about your benefits, please call our Member Services department at the number on your SOLIS ID card.

Report concerns to us:

  • If you see something suspicious or have a question about your plan statement or benefits, call our Member Services department at the number on your ID card.You may also report your concerns anonymously by calling the SOLIS Fraud Hotline toll free at 833-896-3762.

  • You can also report suspected fraud or abuse directly to Medicare. Call the Medicare fraud tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950. Email: You can also send up to 10 pages describing the incident to HHSTips@oig.hhs.gov.

Enrollment

Your SOLIS Experience Made Personal
We know making the right healthcare choice can often be confusing!
Which is why we’d love to speak with you.
EASY ways to enrollment
1. A Personalized Visit

We want to make sure you are well informed about all the benefits that are made available to you. We have an expert team of certified Sales Associates, who are ready to visit you and help answer any questions you may have.


To schedule an appointment with a certified SOLIS Sales Associate, please contact us at: (844) 447-6547.


Hours of Operation:

8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31

8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30

2. Download the Enrollment Form

Our enrollment application may be accessed by clicking here.

Our SOLIS website will guide you in finding answers to any of the health plan questions you may have.


Please feel free to print and send your completed enrollment form to :


SOLIS Health Plans, Inc. (HMO)

Member Services Department

9250 NW 36TH Street, Suite 400

Doral, FL 33178


3. Medicare Beneficiaries may also enroll in SOLIS Health Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov


Disenrollment

Rights & Responsibilities Upon Disenrollment

SOLIS Health Plans, Inc. (HMO), upon receipt of a disenrollment request, will send you a disenrollment acknowledgement letter within ten (10) calendar days. Once CMS confirms the disenrollment, the plan will send you a disenrollment confirmation letter. These notices include explanations of restrictions during the lock-in period and the effective date of the disenrollment. You must continue to use the plan until the disenrollment is effective.


If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment. If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. ("Creditable" coverage means the coverage is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage.) See Chapter 6, Section 9 of your EOC for more information about the late enrollment penalty.


As a member of the plan it is your responsibility to notify us if you have moved out of the plan service area. If you are not sure if you moved out of our area, please contact the Member Services Department (844) 447-6547. TTY users should call 711. We are open October 1 – March 31: 7 days a week, from 8:00 a.m. to 8:00 p.m., Eastern Standard Time and April 1 – September 30: Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Standard.


How to File a Grievance and/or Appeal

You or your authorized representative may file a grievance or appeal request either verbally or in writing.

To file a Grievance and/or Appeal, you can contact SOLIS Health Plans in one of these ways:
  • By phone:

    Call SOLIS Member Services department at 1-844-447-6547, TTY 711

    8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31

    8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30

  • Fax or mail the form:

    If you prefer, you can download a copy of the form below and fax or mail to the below:

    • Fax number:1-833-615-9263

    • Mailing address:

      SOLIS Health Plans, Inc.

      PO Box 524173

      Miami, FL 33152

You can also file a complaint on Medicare.gov website


Click here for instruction on How to File a Grievance or Appeal


Request for Redetermination of Medicare Prescription Drug Denial Form click here


Grievance and Appeals Request Form click here

How to Appoint a Representative

In order for SOLIS to process a Grievance or/and Appeal request from someone other than you (the member), your physician, your prescribing physician (Part D), or other prescriber (Part D), we must have authorization from you. You may appoint any individual as your representative by sending us an Appointment of Representative form signed by both you and the representative. A representative who is appointed by the court or who is acting in accordance with state law may also file a request for you after sending us the legal representative form. You will not need to complete an Appointment of Representative Form if you provide an equivalent written notice or other legal representation document with your request.


Instructions on how to Appoint a Representative click here


You also can get the Appointment of Representative form on CMS's website.


If you have any questions, please call SOLIS Member Services department at 1-844-447-6547, TTY 711,

8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31

8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30


Appointment of Representative Form click here


Contact numbers for members and physicians who have questions and need to inquire about the status of the Grievance and/or Appeal processes


Members:

Please call the SOLIS Member Services department at 1-844-447-6547, TTY 711

8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31

8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30


Provider/Physicians:

Please call the SOLIS Provider Services department at 1-833-615-9259, Monday to Friday, 8 a.m. to 5p.m. Our fax number is 1-833-615-9263.


How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with SOLIS Health Plans click here


You can also find detailed information regarding grievances and the appeals process in the SOLIS Evidence of Coverage (EOC). Links to the EOC can be found on the Our Plans page.

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by SOLIS Health Plans, Inc. (HMO) at no additional cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.


To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.


To qualify for SOLIS’ MTM program, you must meet ALL of the following criteria:

  1. Have at least 3 of the following conditions or diseases:

    • Alzheimer's Disease
    • Bone Disease-Arthritis-Osteoporosis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Mental Health-Depression
    • Asthma /Chronic Obstructive Pulmonary Disease (COPD)
  2. AND Take at least 8 covered Part D medications, AND

  3. Are likely to have medication costs of covered Part D medications greater than $4,044 per year.


To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

  1. Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.

  2. Comprehensive medication review: at least once per year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially via telephone by pharmacies operated by SinfoníaRx. The CMR may also be provided in person at your provider’s office, pharmacy, or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider. These services are provided on behalf of SOLIS Health Plans. This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:

    • Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.

    • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.


To obtain a blank copy of the Personal Medication List (PML) that can help you and your health care providers keep track of the medications you are taking, click here.


If you take many medications for more than one chronic health condition contact your drug plan to see if you’re eligible for MTM, or for more information, please contact Member Services at 844-447-6547 (TTY 711).


Hours of Operation:

8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31

8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30


Member Rights

Regardless of how an individual obtains their Medicare benefit, every member has certain rights and protections as it relates to their health care. The following are the rights and protections for everyone with Medicare:

  • Be treated with dignity and respect at all times.

  • Be protected from discrimination. Every company or agency that works with Medicare must obey the law. They can't treat you differently because of your race, color, national origin, disability, age, religion, or sex.

  • Have your personal and health information kept private.

  • Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.

  • Get understandable information about Medicare to help you make health care decisions, including:

    • What’s covered.

    • What Medicare pays.

    • How much you have to pay.

    • What to do if you want to file a complaint or appeal.

    • Have your questions about Medicare answered.

    • Have access to doctors, specialists, and hospitals.

    • Learn about your treatment choices in clear language that you can understand and participate in treatment decisions.

  • Get health care services in a language you understand and in a culturally-sensitive way.

  • Get Medicare-covered services in an emergency.

  • Get a decision about health care payment, coverage of services, or prescription drug coverage.

  • When a claim is filed, you will get a notice letting you know what will and won’t be covered.

  • If you disagree with the decision of your claim, you have the right to file an appeal.

  • Request a review (appeal) of certain decisions about health care payment, coverage of services, or prescription drug coverage.

  • If you disagree with a decision about your claims or services, you have the right to appeal.

  • File complaints (sometimes called "grievances"), including complaints about the quality of your care.

In addition to the protections described above, every member of Solis has the following protections.
  • Choose health care providers within the Solis plan, so you can get the health care you need.

  • Get a treatment plan from your doctor.

  • If you have a complex or serious medical condition, a treatment plan lets you directly see a specialist within the Solis plan as many times as you and your doctor think you need.

  • Women have the right to go directly to a women's health care specialist without a referral within the Solis plan for routine and preventive health care services.

  • Know how your doctors are paid.

  • When you ask Solis health plan how it pays its doctors, Solis must tell you.

  • Medicare doesn't allow Solis to pay doctors in a way that could interfere with you getting the care you need.

  • Request an appeal to resolve differences with Solis.

  • File a complaint (called a "grievance") about other concerns or problems with Solis.

  • Get a coverage decision or coverage information from Solis before getting services.

  • Request materials and/or assistance in language and formats other than written English, such as Braille, Audio or Sign language, if necessary.

  • Expect that Solis will provide its Notice of Privacy Practices without his/her request.


Member Responsibilities

Members have a responsibility to:

  1. Notify the Company and Health Care Providers of any changes that may affect his/her participation, health care needs or benefits. Some examples include, but are not limited to, the following:

    • Change of address or phone number;

    • Other health insurance;

    • Special medical condition;

    • Change in PCP;

    • Relocation to another county or state.

  2. Ensure his/her benefits are up to date and do not expire.

  3. Ensure that all information is up to date.

  4. Cooperate with the Company and Health Care Providers and follow guidelines given to him/her about the Company.

  5. Follow the Health Care Provider’s instructions about his/her care. This includes:

    • Making appointments with the Health Care Provider

    • Canceling appointments when he/she cannot make the appointment; and

    • Contacting the Company when he/she has questions.

  6. Treat Health Care Providers and staff with respect and dignity.

  7. Discuss and agree upon goals for treatment with the Health Care Provider to the degree he/she is able to do so.

  8. Communicate with his/her Health Care Provider to understand his/her health problems to the degree he/she is able to do so.


SOLIS Health Plans is a HMO with a Medicare contract and a contract with the Florida Medicaid Program. Enrollment in SOLIS Health Plans, Inc. depends on contract renewal. Atención: Si usted hable español, servicios de asistencia en español, de forma gratuita, están disponible para usted. Llame al 1 (844) 447-6547 (TTY 711).


National Coverage Determination (NCD) changes are listed here.

Drug Coverage Determination
Some Prescription Drugs Require Authorization

Certain drugs require a coverage determination. If your drug requires this action, you, your appointed representative, or your prescribing physician or other prescriber will need to request and receive approval in order for SOLIS Health Plans (HMO) to cover your drug.


Drug Coverage Determination

Why is a drug coverage determination required?


SOLIS has placed this requirement on selected high-risk or high-cost medications. We want to make sure these medications do not affect with others you take or add to your costs unnecessarily. Coverage determination conditions are established by our Pharmacy and Therapeutics Committee with involvement from providers, manufacturers, peer-reviewed literature, research, and other experts.


Coverage Determination Request

To request a drug coverage determination, you, your appointed representative, or your prescribing physician or other prescriber can contact SOLIS in one of the following ways:

  • Ask your prescribing physician or other prescriber to submit the request for you

Your prescribing physician or other prescriber may call our Pharmacy Coverage Determination Review team at 1-833-615-9259and request a coverage determination request over the phone. We are available to take your prescriber’s call Monday to Friday, 8 a.m. to 5p.m.


Alternatively, your prescribing physician or other prescriber can submit a coverage determination request form for you. Your prescriber may call the Pharmacy Coverage Determination Review team at the number provided above and request a coverage determination form specifically designed for the drug that is being requested and submit the completed form to us by fax at 1-855-668-8552. This form will include specific questions to ensure all required information is obtained for the review. Your physician can also submit the request for you online by filling out the Coverage Determination Request Form, which is a general form. This form may require for the Pharmacy Coverage Determination Review team to contact your prescriber to obtain additional information that is specific to the drug that is being requested.


For process or status questions, your prescribing physician or other prescriber may call the Pharmacy Coverage Determination Review team at the number listed above.

  • Fax or mail the form - You can download a copy of the form below and fax or mail it to SOLIS

Coverage Determination Request Form


Fax number: 1-855-668-8552


Mailing address:

SOLIS Health Plans

Attention: Pharmacy coverage determination review team

PO Box 1039

Appleton, WI 54912-1039


Note: You can also access the Drug Determination Request Form at the CMS part D webpage link below: Part D Coverage Determination Request Form (for use by enrollees and providers)


If you have any questions or concerns, please contact our Member Services department at 1-844-447-6547,TTY 711, from 8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31 and 8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30. You may always leave a voicemail message after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day.