Important documents for you Summary of Benefits (SB)The Summary of Benefits tells you about some of the characteristics of the plan. It does not include all covered services or all limitations or exclusions. For a complete list of benefits, refer to the Evidence of Coverage. Click on the plan to download the summary of benefits AhorroMax (HMO)Pre-Enrollment ChecklistSummary of BenefitsBasic (HMO)Pre-Enrollment ChecklistSummary of BenefitsBrillante (HMO-POS)Pre-Enrollment ChecklistSummary of BenefitsContigo Plus (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsEnlace Plus (HMO)Pre-Enrollment ChecklistSummary of BenefitsMagno (HMO-POS)Pre-Enrollment ChecklistSummary of BenefitsReal (HMO)Pre-Enrollment ChecklistSummary of Benefits Platino Advance (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsPlatino Blindao (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsPlatino Enlace (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsPlatino Plus (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsPlatino Selecto (HMO-SNP)Pre-Enrollment ChecklistSummary of BenefitsPlatino Titán (HMO-SNP)Pre-Enrollment ChecklistSummary of Benefits Óptimo (PPO)Pre-Enrollment ChecklistSummary of BenefitsÓptimo Plus (PPO)Pre-Enrollment ChecklistSummary of BenefitsÓptimo Xtra (PPO)Pre-Enrollment ChecklistSummary of Benefits Evidence of Coverage (EOC)The EOC gives you details about your Medicare health care and prescription drug coverage for the calendar year. It also explains how to get coverage for the services and prescription drugs you need. This is an important legal document. Click on the plan to download the evidence of coverage AhorroMax (HMO)Basic (HMO)Brillante (HMO-POS)Contigo Plus (HMO-SNP)Enlace Plus (HMO)Magno (HMO-POS)Real (HMO) Platino Advance (HMO-SNP)Platino Blindao (HMO-SNP)Platino Enlace (HMO-SNP)Platino Plus (HMO-SNP)Platino Selecto (HMO-SNP)Platino Titán (HMO-SNP) Óptimo (PPO)Óptimo Plus (PPO)Óptimo Xtra (PPO) Annual Notice of Change (ANOC)This document is sent to members every fall to inform you about all the changes to benefits, costs, providers, and prescription drugs for the next year. The ANOC helps you compare your current health and prescription drug benefits and costs with those for next year. Click on the plan to download the annual notification of changes AhorroMax (HMO)Basic (HMO)Brillante (HMO-POS)Contigo Plus (HMO-SNP)Enlace Plus (HMO)Magno (HMO-POS)Real (HMO) Platino Advance (HMO-SNP)Platino Blindao (HMO-SNP)Platino Enlace (HMO-SNP)Platino Plus (HMO-SNP)Platino Ultra (HMO-SNP)Platino Titán (HMO-SNP) Óptimo (PPO)Óptimo Plus (PPO)Óptimo Xtra (PPO) Provider and Pharmacy Directory Provider DirectoryThis document provides you with a list of all our contracted health care providers such as primary care physicians, specialists, hospitals, outpatient facilities among other health professionals. This directory contains contracted providers and preferred network providers. DOWNLOAD PROVIDER DIRECTORY Pharmacy DirectoryThe Pharmacy Directory gives you a complete list of pharmacies in our network, which means that all of these pharmacies have agreed to fill covered prescriptions for members of our plan. This directory contains contracted pharmacies and preferred network pharmacies. DOWNLOAD PHARMACY DIRECTORY List of Durable Medical Equipment (DME) The Durable Medical Equipment (DME) list information about brands, equipment manufacturers and medical providers in this plan, as described in your Evidence of Coverage. DOWNLOAD LIST OF DURABLE MEDICAL EQUIPMENT Guide for Over-the-Counter (OTC) Drugs and items This guide includes over-the-counter (OTC) medications and health-related items that do not require a prescription to help treat injuries or illnesses. It contains a list of some commonly used drugs, but does not include all the drugs covered by the plan and some items that assist in your health care. This list was selected by a team of health professionals and represents the therapies of medications and non-prescription items that we understand are important to complement your treatment program with prescription drugs. DOWNLOAD GUIDE FOR OVER-THE-COUNTER (OTC) DRUGS AND ITEMS Star Rating Medicare One of the most important goals for the Centers for Medicare & Medicaid Services (CMS) is to make the quality of Medicare Advantage plans transparent for their beneficiaries. To achieve this goal, Medicare Advantage plans are rated every year on a one- to five-star scale. The Medicare Program rates how well Medicare health and drug plans perform in different categories (for example, detecting and preventing illness, ratings provided by patients, patient safety, drug pricing, and customer service). This score provides an overall measure of a plan’s quality, and is a cumulative indicator of the quality of care, access to care, responsiveness, and plan beneficiary satisfaction. One star represents poor performance, while a five-star rating is considered excellent. The plan ratings are posted on the Medicare website to provide beneficiaries with additional information to help them choose among the Medicare Advantage plans offered in their area. You can visit www.medicare.gov for more information. If you would like to get additional information on our plan’s performance please call 1-888-620-1919, from Monday through Sunday, from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-866-620-2520. DOWNLOAD STAR RATING MEDICARE HMO DOWNLOAD STAR RATING MEDICARE PPO
