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You must read this information before you enroll in UCare for Seniors

• UCare Minnesota and UCare Wisconsin, Inc. are health plans with Medicare contracts. These contracts are renewed annually. The availability of coverage beyond the end of the current year is not guaranteed.
• You must have Part A and Part B to enroll.

• Members must use plan providers for routine care except for emergency care, out-of-area renal dialysis/urgent care, (and in-area urgent care when the UCare for Seniors network is temporarily unavailable), and Point-of-Service benefits. If you obtain care from out-of-network providers neither Medicare or UCare for Seniors will be responsible for the costs.

• Members may enroll in the plan only during specific times of the year. Contact UCare for more information.
• Medicare beneficiaries may enroll in UCare for Seniors through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
• You must continue to pay your Medicare Part B premium.
• Limitations, co-payments, and restrictions may apply.
• For information on major exclusions and limitations, click here.
• You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
• Your State Medicaid office.
• The UCare for Seniors Medicare prescription drug benefit is only available to members of UCare for Seniors Classic, Value Plus, and Standard D plans.
• Premiums listed are for both medical services and prescription drug benefits (Standard D, Value Plus and Classic only).
• Part D benefits are only available at network pharmacies except in non-routine circumstances, and quantity limitations and restrictions may apply.
• The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.
• Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013.
• For information about Coverage Determinations, Appeals, and Grievances, click here.
• Sales kit materials:
• Cover letter (PDF)
• A Guide to Comparing your Options
• Minnesota (PDF)
• Wisconsin (PDF)
• Summary of Benefits
• Minnesota (PDF)
• Wisconsin (PDF)
• Plan Rating Information
• Minnesota (PDF)
• Wisconsin (PDF)
• Comprehensive Dental Plan Rider Overview
• Comprehensive Formulary (PDF)
• Information about the UCan! UCare Activity Network
• This information is available in alternate formats or languages. Please call 1-877-523-1518 toll free (TTY 1-800-688-2534 toll free) to request this information in other formats or languages.