HealthChoice Medicare Supplement Plans
The HealthChoice Medicare Supplement Plans With and Without Part D provide coverage throughout the United States.
| HealthChoice is contracted with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Part D Prescription Drug benefits through our HealthChoice Medicare Supplement Plans With Part D. |  |
If you already have Medicare Part D benefits through your employer, union, or other source, you must enroll in one of the HealthChoice Medicare Supplement Plans Without Part D. Your coverage will be the same and include prescription drug benefits, but it will not include Medicare Part D benefits.
Premiums
- 2013 Former Employees and Surviving Dependents Premiums
- 2013 Former Employee Medicare and Medicare Advantage Prescription Drug (MA-PD) Plans Monthly Premiums
- 2013 Premiums for Members Receiving Extra Help from Medicare
- 2013 Premiums for Higher Income Members
Health Benefits Information
- Filing a Claim for Health Benefits
- HealthChoice Medicare Supplement Plans Handbook PDF Version (1.4 mb)
- Health Benefits Chart
Pharmacy Benefits Information
Pharmacy and Formulary Information
- The HealthChoice Pharmacy Network
- Medicare Formulary Search: High Option Plans*
- Medicare Formulary Search: Low Option Plans*
- Pharmacy Benefits Chart for High and Low Option Plans
- Non-Network Pharmacy Benefits
- Notice Regarding Formulary Change
- 2013 HealthChoice Medicare Comprehensive Formulary E7848_H6000 CMS Approved 08/15/12
Policies and Procedures for Pharmacy Benefits
- Accessing Part D Medications During a Declared Disaster or Other Health Emergency
- Filing a Pharmacy Claim
- Medicare Coverage Gap Discount Program (Only Plans With Part D)
- Medications with Quantity Limits
- Medications Requiring Prior Authorization
- Medications Requiring Step Therapy
- Medication Therapy Management (Only Plans With Part D)
- Non-Covered Medications
- Non-Formulary Medications
- Specialty Medications
- Step Therapy - Trying a Different Drug First
- Transition Supply of Medication (Only Plans With Part D)
Forms and Applications
- Application for Medicare Advantage Prescription Drug (MAPD) Plan - For 2013 enrollments only.
- 2013 Application for Medicare Supplement With Part D - For 2013 enrollments only.
- Appointment of Representative Form - Medicare - (CMS-1696)
- Authorization to Disclose Health Information - HealthChoice
- Direct Claim Form for Pharmacy - Medicare
- Disenrollment Letter and Form - Medicare
- Pharmacy Request for Coverage Determination – Medicare Part D
- Pharmacy Request for Coverage Redetermination – Medicare Part D
- Revocation of Authorization to Disclose Health Information - HealthChoice
Grievance and Appeals Information
- Grievance and Appeals Summary for Health Benefits (All Medicare Supplement Plans)
- Grievance and Appeals Guide for Pharmacy Benefits (Plans With Part D)
- Grievance and Appeals Summary for Pharmacy Benefits (Plans With Part D)
- Grievance and Appeals Summary for Pharmacy Benefits (Plans Without Part D)
General Information
- Extra Help Paying for Prescription Costs (Only Plans With Part D)
- Disenrollment Information - Ending Your Coverage with HealthChoice
- Protecting Your Personal Information
- Providing Information in a Way That Works For You
- Best Available Evidence Policy*
Contact Information
Plan Notices
- Creditable Coverage Notices
- HealthChoice Medicare Supplement Plans' Notice
- HIPAA Privacy Notice
- Medicare Contracting Notice
- Non-Discrimination Notice
By clicking any link designated with an asterisk (*), you will be leaving the HealthChoice website and EGID privacy policies will not apply.
Last Modified on 04/11/2013