Univera SeniorChoice Select (HMO-POS)

For Coverage January 1, 2019 to December 31, 2019

Plan Features

  • Robust provider network1
  • No referrals required
  • Coverage for preventive dental care including 2 oral exams, 2 cleanings, and 2 x-rays per year2
  • $120 annual eyewear allowance
  • Worldwide urgent care and emergency coverage
  • Silver&Fit® Fitness Program (learn more)
    • $25 annual non-refundable fee to enroll in a participating fitness club or exercise center;
    • $10 annual non-refundable fee to enroll in the home fitness program; or
    • $150 annual allowance for out-of-network facilities.

Benefits3

Medical Coverage
Univera SeniorChoice Select (HMO-POS) provides you reasonably priced, comprehensive coverage for the health care services you need, including:

  • Out-of-Network coverage under the point of service benefit: 30% coinsurance; $1,500 annual maximum.
  • $15 copay per visit for an in-network primary care providers
  • $40 copay per visit for in-network specialists
  • $0 copay for many Medicare-covered preventive services in-network, such as physical exams, smoking cessation and some immunizations
  • $15 copay for in-network chiropractic medical visits
  • Inpatient Hospital Stay
    • $260 copay per day for days 1-5 for each Medicare-covered stay at a network hospital
    • Days 6+ covered in full
  • $5,500 annual Out-of-Pocket Maximum Protection (In-network services)

Learn more with these resources:

1 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. The Point-of-Service (POS) benefit gives extra flexibility to receive some covered services from providers that are not in our network without having to pay the entire cost yourself. The POS benefit has a coverage limit. Once your costs go above this limit, you will be responsible for 100% of the remaining costs for the out-of-network services. For information on how to request reimbursement for Out-of-Network claims, the Point-of-Service (POS) benefit, Out-of-Network Coverage, or Coverage Determinations and Appeals call Customer Care at 1-877-883-9577, 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 (TTY/TDD 1-800-421-1220). Or, see the Evidence of Coverage using the link above. The provider network may change at any time. You will receive notice when necessary.

2 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.

3 This information is not a complete description of benefits. Call 1-844-596-0345 (TTY/TDD 1-800-421-1220) for more information.

To the extent of any discrepancy between this web site and the Evidence of Coverage, the Evidence of Coverage terms take priority.

Univera Healthcare contracts with the Federal Government and 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. .
This page last updated .