Find Your Doctor, Hospital & Pharmacy
With our plans, you have access to thousands of doctors, hospitals and pharmacies:
- Find a Participating Doctor or Specialist
- Find a Participating Dentist
- Find a Participating Pharmacy
- View or Print Our Provider and/or Pharmacy Directories
The pharmacy network and/or provider network may change at any time. You will receive notice when necessary.
Medicare Advantage plans have network providers. These are the doctors and other healthcare professionals, medical groups, hospitals and other healthcare facilities that have an agreement with us to accept payment and any plan cost-sharing as payment in full. We have arranged with these providers to deliver covered services to members in our plan.
- If You Select an HMO Plan...
With an HMO, you must select one of our participating providers as your Primary Care Physician. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from Out-of-Network providers neither Medicare nor Univera Healthcare will be responsible for the costs. See your Evidence of Coverage for more information. Generally, with an HMO, you pay copayments, coinsurance and deductibles for most services.
- With an HMO Point-of-Service (POS) Plan...
You have the extra flexibility to get some covered services from doctors, hospitals, labs or other health care providers that are not in our provider network without paying the entire cost yourself. An annual dollar limit applies to this benefit. Once your costs go above this limit, you're responsible for the remaining costs for the out-of-network services.
- If You Select a PPO Plan...
With a PPO, you don’t need to select a Primary Care Physician. You have access to both In- and Out-of-Network providers and you may see any Medicare participating provider. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in emergencies or urgently needed care. You do not need a referral or prior authorization (prior approval) when you get care from Out-of-Network providers; however, before getting services from Out-of-Network providers you may want to confirm with us that the services you are getting are covered and are medically necessary. Your cost sharing responsibility will be greater Out-of-Network when your Out-of-Network coinsurance is based on the Medicare allowed amount and our In-Network provider contract rate for the service is lower than the Medicare allowed amount.
Univera Healthcare provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis.
- For HMO-POS and PPO Plans...
Out-of-network/non-contracted providers are under no obligation to treat Univera Healthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
You are covered locally and nationally with our extensive pharmacy network of 65,000 pharmacies. Save money with lower copays on your Tiers 1-4 medications when you use one of our 35,000 preferred pharmacies. Higher copays apply for medications on Tiers 1-4 if a standard pharmacy is utilized. Prescriptions filled at non-network pharmacies are covered only in certain situations.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-877-883-9577 (TTY 711),consult the pharmacy directory , or search for your pharmacyLink to an External Website.
We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. We cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. We would cover prescriptions filled at an out-of-network pharmacy if:
- The prescriptions are related to care for a medical emergency or urgently needed care.
- You are unable to get a covered prescription drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
- You are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).
For information on network coverage, how to request reimbursement for Out-of-Network claims, Out-of-Network Coverage or Coverage Determinations and Appeals call Customer Care at 1-877-883-9577 (TTY 711), Monday - Friday, 8 a.m. to 8 p.m.; from October 1 through March 31, 8 a.m. to 8 p.m. 7 days a week , or see the Evidence of Coverage for more information.
Monday - Friday:
8 a.m. to 8 p.m.
From Oct. 1 - March 31:
advisors are also available weekends 8 a.m. to 8 p.m.
Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day
Need information in a different format?
Univera Healthcare is an HMO plan and PPO plan with a Medicare contract. Enrollment in Univera Healthcare depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_8829_C.
This page last updated 10-01-2022.