Terms and Conditions

Terms and Conditions for MA/MAPD

You can find the Summary of Benefits and Star Ratings at uhc.com/Medicare. All plan materials sent to you will be in English unless requested in a different language or format.

As a reminder, this is a Medicare Advantage plan, NOT a Medicare Supplement plan.

UnitedHealthcare Insurance Company or one of its affiliated companies is a Medicare Advantage organization with a Medicare contract. Enrollment depends on contract renewal.

You will receive your Medicare health benefits through UnitedHealthcare instead of Original Medicare.

The plan you have chosen is not a rider, but a full plan.

If you receive any Extra Help, Medicare will pay all or a portion of your drug premiums. We'll bill you for any remainder.

If you didn't have creditable prescription drug coverage when you first became eligible for Medicare, you may have a late enrollment penalty. If this applies to you, we'll send you a letter.

For those with incomes above a certain level, Medicare may apply an extra amount for Part D. If this applies to you, Medicare or the RRB will bill you or withhold it from your Social Security check.

You need to keep both Medicare Parts A AND B.

You can only be in one Medicare Advantage or Prescription Drug plan at a time. Enrolling in this plan may automatically end your enrollment in another Medicare Advantage or Prescription Drug plan.

Medicare doesn't usually cover you while out of the country with the exception of limited coverage near the U.S. border.

Medicare Advantage (Non PFFS) :

To get the lowest costs, you must use in-network providers OR if your plan does NOT have out-of-network coverage, you can only use in-network providers, with the exception of emergency or urgently needed care.

You'll receive an Annual Notice of Change document in the fall. It will explain any changes to benefits, premiums and/or copays on your plan for the next year. You should review your Annual Notice of Change every year to make sure the plan is still a good choice for you.

If you ever disagree with a decision about payment or services, you have the right to file an appeal.

You can only cancel your enrollment in this plan before the plan effective date.

We'll only release your information to Medicare, if necessary, for payment, treatment, and healthcare operations.

Medicare may release your information for research and other purposes, as allowed by federal statutes and regulations.

The information on this enrollment is correct to the best of your knowledge. If you provide answers that you know are not true, you may lose this plan.

Dual Special Needs Plans (D-SNP):

You can only enroll in this dual special needs plan if you have proof that you are eligible for both Medicare and Medicaid. We may contact you for proof.

Medicare Advantage PPO or POS Only:

If the plan offers out-of-network benefits, you may use the plan for covered services as long as the provider accepts the plan, agrees to bill your insurance, and are Medicare Approved. These services may be at a higher cost.

MA Only (Non PFFS):

This plan does not have Prescription drug coverage and you can't be enrolled in a separate Part D plan at the same time you are enrolled in this medical plan.

PFFS MA Only:

This plan does not have prescription drug coverage, and you may be eligible to get coverage from another Medicare prescription drug plan.

PFFS Plans only:

As a reminder, this is a Private-Fee-for-Service plan. You may use any Medicare eligible doctor, hospital or health care provider as long as they are Medicare-approved and they accept the plan’s terms, conditions and payment rates. Before you get services from a provider, please call to make sure they will accept this plan. If the provider does not agree to accept this plan, you will need to find a different provider.

PFFS Plans only:

Providers who do not contract with our plan aren't required to see you except in an emergency. Medicare Private Fee-For-Service plans work differently, and pay for services instead of Medicare. You'll be responsible for the amounts the plan doesn't cover, such as copays and coinsurances.

Institutional Plans (I-SNP):

You can only enroll for this (institutional/institutional equivalent) special needs plan if you have verification that you have or will continue to need the facility's level of services for at least 90 days.

Tricare:

If you have Tricare, your coverage may be affected once your new Medicare Advantage coverage starts. Please contact Tricare for more information.