OneCare (HMO SNP)

Member Documents

Things you may need

Download the 2019 OneCare evidence of coverage Download PDF Icon It lists what is covered, how to get services, your rights as a member, your responsibilities, and much more.

Download the OneCare summary of benefits Download PDF Icon This is a summary, please see the OneCare (HMO SNP) evidence of coverage for the full benefits list.

Download the 2019 OneCare provider directory Download PDF Icon Use the provider directory to find a doctor, specialist, pharmacy or other provider near you.

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OneCare list of covered drugs Includes all covered medications listed by generic name or brand name (if there is one). It also lists criteria for prior authorization and step therapy.

Annual Notice of Change Download PDF Icon Read the 2019 Annual Notice of Change.

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Common forms Find many of the forms you may need.

OneCare plan rating Download PDF Icon The Medicare star rating program rates all health and prescription drug plans each year. It is based on a plan’s quality and performance.

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Other important documents See the Notice of Privacy Practices, Notice of Nondiscrimination and other documents.

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To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H5433_WEB020_M Accepted 06/17/19

OneCare (HMO SNP) is a Medicare Advantage organization with a Medicare contract. Enrollment in OneCare depends on contract renewal. Eligible beneficiaries can enroll at any time. Eligible beneficiaries must have Part A and Part B to enroll in the plan. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Other Pharmacies/Physicians/Providers are available in our network. Medicare beneficiaries may also enroll in OneCare (HMO SNP) through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare has neither reviewed nor endorsed this information. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. OneCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available for free in other languages. Please call our customer service number at 1-877-412-2734, 24 hours a day, 7 days a week. TDD/TTY users should call 1-800-735-2929.

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