OneCare (HMO SNP)

Member Documents

Things you may need

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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.

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Download the 2020 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.

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Download the 2019 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.

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Download the 2020 OneCare summary of benefits Download PDF Icon This is a summary, please see the OC evidence of coverage for the full benefits list.

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Download the 2019-20 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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2019 OneCare list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

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2020 OneCare list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

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

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2020 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.

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2019 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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2020 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_20WEB001_2020_A Accepted 9/29/19

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