HealthChoice Medicare Supplement Plans

The HealthChoice Medicare Supplement Plans With and Without Part D provide coverage throughout the United States. If you move out of the United States, you must notify HealthChoice so that you can be disenrolled and locate a new plan in your service area.

HealthChoice has contracted with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Part D Prescription Drug benefits through our HealthChoice Medicare Supplement Plans With Part D.

If you already have Medicare Part D benefits through your employer, union, or other source, you must enroll in one of the HealthChoice Medicare Supplement Plans Without Part D. Your coverage will be the same and include prescription drug benefits, but it will not include Medicare Part D benefits.

Premiums

• HealthChoice Medicare Supplement Plans With and Without Part D
• HealthChoice COBRA Medicare Supplement Plans With and Without Part D
• Premiums for Members Receiving Extra Help from Medicare

Health Benefits Information

• HealthChoice Medicare Supplement   PDF Version (1.4 Mb)    Searchable Text Version
• Health Benefits Chart

Pharmacy Benefits Information

Pharmacy and Formulary Information

• Find a Network Pharmacy*
• Medicare Formulary Search: High Option Plans*
• Medicare Formulary Search: Low Option Plans*
• Pharmacy Benefits Chart
• Non-Network Pharmacy Benefits
• HealthChoice Medicare Formulary (Abridged) for Plan Year 2010
• HealthChoice Medicare Comprehensive Formulary for Plan Year 2010

Policies and Procedures for Pharmacy Benefits

• Medications Limited in Quantity
• Quantity Limitations *NEW*
• Medications Requiring Prior Authorization
• Prior Authorization Requirements *NEW*
• Medication Therapy Management (Only Plans With Part D)
• Non-Covered and Non-Formulary Medications
• Pharmacy Prior Authorization Process
• Pharmacy Access During a Declared Disaster
• Specialty Medications (Only Plans Without Part D)
• Step Therapy *NEW*
• Transition Supply of Medication (Only Plans With Part D)

Forms and Applications

• Application for HealthChoice Employer PDP Medicare Supplement With Part D (Rev. 09/08/09)
• Medicare - Direct Claim Form (Rev. 08/08)
• Medicare - Disenrollment Letter and Form (Rev. 05/27/09)
• Medicare - Pharmacy Coverage Determination - Member (Rev. 2006)
• Medicare - Pharmacy Coverage Determination - Physician (Rev. 2006)
• Medicare - Vaccine Claim Form (Rev. 10/07)

Grievance and Appeals Information

• Grievance and Appeals Summary for Health Benefits (All Medicare Supplement Plans)
• Grievance and Appeals Summary for Pharmacy Benefits (Plans With Part D)
• Grievance and Appeals Guide for Pharmacy Benefits (Plans With Part D)
• Grievance and Appeals Summary for Pharmacy Benefits (Plans Without
  Part D)

General Information

• Extra Help Paying for Prescription Costs (Only Plans With Part D)
• Ending Your HealthChoice Coverage
• Protecting Your Personal Information

Contact Information

• Plan Contact Information
• Grievance and Appeals Contact Information

Plan Notices

• Contracting Notice
• HIPAA Privacy Notice
• HealthChoice Medicare Supplement Plans Notice
• Notices of Creditable Coverage