HealthChoice Medicare Supplement Plans
The HealthChoice Medicare Supplement Plans With and Without Part D provide coverage throughout the United States. If you move out of the United States, you must notify HealthChoice so that you can be disenrolled and locate a new plan in your service area.
HealthChoice has 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
Health Benefits Information
- HealthChoice Medicare Supplement PDF Version (1.4 Mb) Searchable Text Version
- Health Benefits Chart
Pharmacy Benefits Information
Pharmacy and Formulary Information
Policies and Procedures for Pharmacy Benefits
- Medications Limited in Quantity
- Quantity Limitations *NEW*
- Medications Requiring Prior Authorization
- Prior Authorization Requirements *NEW*
- Medication Therapy Management (Only Plans With Part D)
- Non-Covered and Non-Formulary Medications
- Pharmacy Prior Authorization Process
- Pharmacy Access During a Declared Disaster
- Specialty Medications (Only Plans Without Part D)
- Step Therapy *NEW*
- Transition Supply of Medication (Only Plans With Part D)
Forms and Applications
- Application for HealthChoice Employer PDP Medicare Supplement With Part D (Rev. 09/08/09)
- HIPAA Authorization to Disclose Health Information (Rev. 01/14/08)
- HIPAA Revocation of Authorization to Disclose Health Information (Rev. 03/15/06)
- Medicare - Direct Claim Form (Rev. 08/08)
- Medicare - Disenrollment Letter and Form (Rev. 05/27/09)
- Medicare - Pharmacy Coverage Determination - Member (Rev. 2006)
- Medicare - Pharmacy Coverage Determination - Physician (Rev. 2006)
- Medicare - Vaccine Claim Form (Rev. 10/07)
Grievance and Appeals Information
General Information
Contact Information
Plan Notices
Last Modified on 04/14/2010