Sierra Health and Life Insurance Company, Inc.




	Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Notice of Privacy Practices 2010 Plan Description 2010 Summary of Benefits 2010 Resumen de Beneficios (Summary of Benefits - Spanish) 2010 Evidence of Coverage 2010 Summary of Benefits 2010 Resumen de Beneficios (Summary of Benefits - Spanish) 2010 Evidence of Coverage 2010 Summary of Benefits 2010 Resumen de Beneficios (Summary of Benefits - Spanish) 2010 Evidence of Coverage Sierra Spectrum and Sierra Nevada Spectrum Pharmacy List and Provider Directory Directorio de Proveedores del Plan (Pharmacy List and Provider Directory - Spanish) Prescriptions Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Formulary Deletions Change Update 2010 Formulary 2010 Prior Authorization Criteria 2010 Step Therapy Criteria Formulary Medication Limitations Medicare Transitional Care Policy and Procedure Vaccine Administration Notice Information for People with Limited Income and Resources Grievances and Appeals for Part D Coverage Determinations and Redeterminations Exceptions and Prior Authorizations 2010 Direct Member Reimbursement Form CMS Best Available Evidence (BAE) Policy Programs Member Services HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Member Services HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Member Services HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Member Services HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter Member Services 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 plan that gives you the coverage and flexibility you want in a health plan.

To find out about Sierra Nevada Spectrum, call 1-877-883-9444; TTY: 1-800-349-3538.

For Member Services, call 1-877-559-4512; TTY: 1-800-349-3538. Member Services hours: From March 2 through November 14, we are open Monday - Friday from 8 am to 8 pm. Calls on Saturday, Sunday and holidays will be received by our automated phone system (where you can leave a detailed message and a representative will return your call as soon as possible). From November 15 through March 1, we are open seven days a week from 8 am to 8 pm.

Sierra Nevada Spectrum is a Medicare Advantage PPO plan offered by Sierra Health and Life Insurance Company, Inc., a UnitedHealthcare Company. Sierra Health and Life Insurance Company, Inc. is a health plan with a Medicare contract. Anyone with Medicare Parts A & B may apply. You must continue to pay your Medicare Part B premium. Prescription coverage subject to limitations. The use of non-plan or non-preferred providers is allowed but may cost more to the beneficiary.

Beneficiary information is available in alternate formats and languages. Please call Member Services for details.

CMS Approval Date: 11/2009

R5674_ 41NVSHL09651

Last update: 08/10