Basic (HMO)

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.

The EOC gives you details about your Medicare healthcare for the calendar year. It also explains how to get coverage for the services you need. This is an important legal document.

This document is sent to members every fall to inform you about all the changes to benefits, costs, and providers for the next year. The ANOC helps you compare your current health benefits and costs with those for next year.

The Durable Medical Equipment (DME) lists information about brands, equipment manufacturers and medical providers in this plan, as described in your Evidence of Coverage.

This document provides you with a list of all our contracted healthcare providers such as primary care physicians, specialists, hospitals, outpatient facilities among other health professionals. This directory contains contracted providers and preferred network providers.

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 healthcare. 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.