Univera Medicare Freedom (HMO-POS)
For Coverage January 1, 2023 to December 31, 2023
| Primary Care Doctor/Specialist Copay Per Visit | Prescription Drugs | Preventive Dental | Eyewear |
|---|---|---|---|
| $5/$35 (In-network) | Not Covered | Covered | $250 per year |
| Primary Care Doctor/Specialist Copay Per Visit | Prescription Drugs |
|---|---|
| $5/$35 (In-network) | Covered |
| Preventive Dental | Eyewear |
|---|---|
| Covered | $250 per year |
$0 Routine Eye Exam and $250 Annual Eyewear Allowance
Annual Routine Hearing Exam $0 copay, Hearing Aids $499 & $799 per unit
Not Covered
$50 allowance every three months for items such as allergy medication, antacids, digestive aids, cold & flu medication, denture products, and more.
Get care from the people and places you know and trust using our robust network of doctors, hospitals, and pharmacies. Along with urgent and emergency care when you travel.
Telehealth for care by telephone, email or chat
Get mental health support via in-person and telehealth visits, with a participating licensed therapist ($0 copayment) and/or psychiatrist (specialist copay applies).
Our local team of doctors, nurses, dietitians and specialists are here to support your wellbeing, including healthy eating, managing prescriptions, health conditions, and more. Plus, members have access to our 24/7 Nurse Call Line.
With the Silver&Fit® Fitness Benefits Program you can join a participating fitness center for a $0 annual fee, workout from home with a home fit kit (1 kit / $0 annual fee), and access online digital workouts.
Medical Coverage
Univera Medicare Freedom (HMO-POS) provides comprehensive coverage for the health care services you need, including:
| SERVICES | COST |
|---|---|
| Monthly Premium | $0 |
| Part B Refund | $35 per month Part B refund in your Social Security check |
| Primary Care Doctor Visit (In-network) | $5 copay |
| Specialist Visit (In-network) | $35 copay |
| Preventive Dental | $0 copay |
| Eyewear Allowance | $250 per year |
| Inpatient Hospital Stay (In-network) | $260 copay (per day) for days 1-5, days 6+ covered in full |
| Outpatient Hospital Coverage (In-network) | $250 copay |
| Urgent Care | $50 copay |
| Emergency Care | $95 copay |
| Ambulance | $150 copay |
| Maximum Out-of-Pocket (In-network) | $4,500 per year |
| NEW! Meals | Up to two home-delivered meals per day for 7-days. Available after an inpatient hospital, hospital observation, or Skilled Nursing Facility stay. |
Prescription Drug Coverage is not included in this plan.
Want to Meet?
Need Help?
Speak with one of our dedicated Medicare Sales Advisors.
Call:
1-844-596-0345
TTY: 711
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?
Call Customer Service toll-free at 1-877-883-9577 (TTY 711) 8 a.m. to 8 p.m. Monday - Friday. From Oct. 1 to Dec. 31, representatives also are available weekends from 8 a.m. to 8 p.m.
Register for a Medicare Plans Seminar
Join us for a Medicare Seminar to learn more and let us help you choose the right plan.
Learn more with these resources:
- Summary of Benefits with Multi-Language FlyerOpen a PDF
- Evidence of CoverageOpen a PDF
- Annual Notice of ChangeOpen a PDF
- Plan Ratings
- Disenrollment Rights & Responsibilities
This information is not a complete description of benefits. Call 1-800-671-6081 (TTY 711) for more information.
Network Coverage Information - With our Medicare Advantage Health Maintenance Organization (HMO) plans 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. For information on how to request reimbursement for Out-of-Network claims from emergency, urgent or other services, 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 using the link above. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
For out-of-network providers, we will pay 100% of the allowance or dentist charges, whichever is less. You will be responsible for the balance.
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.
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
To the extent of any discrepancy between this web site and the Evidence of Coverage, the Evidence of Coverage terms take priority.
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_M.
This page last updated 10-01-2022.
