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SecurityChoice Plans and Benefits

PW_A102915

  Plan Brochure Important Information for Members & Providers Summary of Benefits Evidence of Coverage
Classic 
 
PDF Format  
PDF Format  
PDF Format  
Plus 
 
PDF Format  
PDF Format  
PDF Format  
Essential 
 
PDF Format  
PDF Format  
PDF Format  
Essential Plus 
 
PDF Format  
PDF Format  
PDF Format  
 
Current customers should contact our Customer Service Department.
Enrollment Materials
Limited Income Subsidy (LIS)*
Prescription Drug Plan Conditions and Limitations
SecurityChoice Plus and Essential Plus PFFS - Prescription Drug Online Formulary Search
SecurityChoice Plus and Essential Plus PFFS – Downloadable Comprehensive Formulary PDF
Formulary Transition Notice
Grievance & Appeals Information (for plans without prescription drug benefits)
Grievance & Appeals Information (for plans with prescription drug benefits)
Request Form - Coverage Determination, Formulary Exception or Tiering Exception
Quality Assurance (for plans without prescription drug benefits)
Quality Assurance (for plans with prescription drug benefits)
Prescription Drug Claim Form
HIPAA Privacy Notice
 
*In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan. In order to address these special situations, CMS has created the Best Available Evidence (BAE) policy. This policy requires Part D plans to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate. For more information about this CMS policy, click here  
 
Appointing a representative 
An appointed representative is a relative, friend, advocate, doctor or other person authorized to act on your behalf in obtaining a grievance, coverage determination or appeal. 
Those not authorized under state law to act for you will need to sign an Appointment of Representative Form and mail it to the appropriate plan Customer Service department. Click here for the Customer Service mailing address for you plan.  
 
If you are interested in getting more information about SecurityChoice, contact your UniCare agent or click here to contact UniCare’s New Enrollment department.  
 
 
Anthem Smart Value PFFS Classic and Plus plans are Health Plans with a Medicare contract that is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. 
To obtain an aggregate number of grievances, appeals and exceptions filed or for full information on benefits, please call the Customer Service Department.  
Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits.  
 
Material Identification M0013_09_221, CMS Approved 09/25/2009  
Last Updated 9/25/2009  
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