Sierra Health and Life Insurance Company, Inc.

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	Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment 2012 Plan Description 2012 - New Preventive Services 2012 Summary of Benefits 2012 Resumen de Beneficios (Summary of Benefits - Spanish) 2012 Evidence of Coverage 2012 Constancia de Cobertura (Evidence of Coverage - Spanish) 2012 - New Preventive Services 2012 Summary of Benefits 2012 Resumen de Beneficios (Summary of Benefits - Spanish) 2012 Evidence of Coverage 2012 Constancia de Cobertura (Evidence of Coverage - Spanish) 2012 - New Preventive Services 2012 Summary of Benefits 2012 Resumen de Beneficios (Summary of Benefits - Spanish) 2012 Evidence of Coverage 2012 Constancia de Cobertura (Evidence of Coverage - Spanish) 2012 - New Preventive Services 2012 Summary of Benefits 2012 Resumen de Beneficios (Summary of Benefits - Spanish) 2012 Evidence of Coverage 2012 Constancia de Cobertura (Evidence of Coverage - Spanish) 2012 - New Preventive Services 2012 Summary of Benefits 2012 Resumen de Beneficios (Summary of Benefits - Spanish) 2012 Evidence of Coverage 2012 Constancia de Cobertura (Evidence of Coverage - Spanish) Sierra Nevada Spectrum Searchable Provider Directory Sierra Spectrum/Sierra Nevada Spectrum Provider Directory Directorio de Proveedores del Plan (Pharmacy List and Provider Directory - Spanish) Prescriptions Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Pharmacy Saver Program Formulary Medication Limitations Searchable Formulary including Step Therapy and Prior Authorization Documents Grievances and Appeals for Part D Direct Member Reimbursement Form 2012 Formulary 2012 Formulario Completo (Formulary - Spanish) Information for People with Limited Income and Resources Prescription Drug Transition Process Formulary Updates Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Programs Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter

Sierra Nevada Spectrum

Sierra Nevada Spectrum (Regional PPO) is a Preferred Provider Organization Medicare Advantage plan

Sierra Nevada Spectrum (Regional PPO) will not be renewing its Medicare contract effective January 1, 2013. You may choose to enroll in our plan, but your coverage will automatically end on December 31, 2012. Because this plan ends on December 31, 2012, if you decide to join, you are entitled to enroll in a new MA plan or PDP beginning December 8, 2012 through February 29, 2013. However, if you want your enrollment in the new plan to take effect on January 1, 2013, the new plan must receive your application by December 31st. You may also have the option of enrolling in a Medicare Cost Plan, if one is offered in your area. If you do not enroll in another MA plan, Medicare Cost Plan or PDP plan by December 31, 2012, you will be disenrolled from our plan and enrolled in Original Medicare on this date.

For Customer Service, call 1-877-559-4512; TTY: 711. Customer Service hours: October 1 through February 14: 8 a.m. to 8 p.m. local time, 7 days a week. Between February 15 through September 30: 8 a.m. to 8 p.m. local time, Monday - Friday. Between February 15 through September 30: 8 a.m. to 8 p.m. local time, Monday - Friday. On Saturday, Sunday and holidays, please leave a detailed message and a representative will return your call within a business day.

Sierra Nevada Spectrum Medicare Advantage plan is insured through Sierra Health and Life Insurance Company, Inc., a UnitedHealthcare Insurance Company and Medicare Advantage organization with a Medicare contract.

Enrollment Limitations: Members may enroll in the plan only during specific times of the year. Contact Sierra Nevada Spectrum for more information. You must have both Medicare Parts A and B to enroll in the plan. You must continue to pay your Medicare Part B premium and use plan providers for routine care.

Sierra Nevada Spectrum (Regional PPO) service area covers Nevada.

For PPO members, with the exception of emergency or out-of-area renal dialysis, it may cost more to get care from out-of-network providers.

Pharmacy Network Limitations: Prescription coverage subject to limitations. You must use contracted network pharmacies to access your Part D prescription drug benefit except under non-routine circumstances, in which case quantity limitations and restrictions may apply.

Beneficiary information is available in alternate formats and languages. Please call Customer Service for details.

The Centers for Medicare & Medicaid Services (CMS) values your feedback and works to continue the quality of the Medicare program. Click the following link to submit your feedback: CMS Medicare Complaint Form

R5674_120928_204344 CMS Approved
Last update: 10/12

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