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 2013 Plan Description 2013 Summary of Benefits 2013 Resumen de Beneficios (Summary of Benefits - Spanish) 2013 Evidence of Coverage 2013 Constancia de Cobertura (Evidence of Coverage - Spanish) 2013 Summary of Benefits 2013 Resumen de Beneficios (Summary of Benefits - Spanish) 2013 Evidence of Coverage 2013 Constancia de Cobertura (Evidence of Coverage - Spanish) 2013 Summary of Benefits 2013 Resumen de Beneficios (Summary of Benefits - Spanish) 2013 Evidence of Coverage 2013 Constancia de Cobertura (Evidence of Coverage - Spanish) 2013 Summary of Benefits 2013 Resumen de Beneficios (Summary of Benefits - Spanish) 2013 Evidence of Coverage 2013 Constancia de Cobertura (Evidence of Coverage - Spanish) 2013 Provider Directory Searchable Provider Directory 2013 Directorio de Proveedores del Plan (Pharmacy List and Provider Directory - Spanish) Prescriptions Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form Coverage Determinations and Redeterminations CMS Best Available Evidence (BAE) Policy Searchable Formulary including Step Therapy and Prior Authorization Documents 2013 Formulary 2013 Formulario Completo (Formulary - Spanish) Pharmacy Saver Program Formulary Updates Medicare Transitional Care Policy and Procedure Prescription Drug Transition Process Information for People with Limited Income and Resources Formulary Medication Limitations Medication Therapy Management (MTM) Program Grievances and Appeals for Part D Direct Member Reimbursement Form 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 UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear Customer Service Passport to Living Healthy Program HIV Screening Requirement for High Risk Populations Member Value Program (MVP) Quality Program Member Newsletter UnitedHealthcare's Medicare Made Clear

Sierra Spectrum

Say HELLO to Sierra Spectrum

Sierra Spectrum (PPO) is a Preferred Provider Organization Medicare Advantage plan that may give you the coverage and flexibility you want in a health plan.

To find out about Sierra Spectrum, call a contracted, independent licensed insurance agent authorized to sell products within the UnitedHealthcare® Medicare Solutions portfolio at 1-877-289-0221 (toll-free); TTY: 711, 8 a.m. to 8 p.m., 7 days a week local time.

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. On Saturday, Sunday and holidays, please leave a detailed message and a representative will return your call within a business day.

A UnitedHealthcare® Medicare Solution

Sierra 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: Enrollment in the plan is available during specific times of the year. Contact Sierra 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, if not otherwise paid for under Medicaid or by another third party.

Sierra Spectrum (PPO) service area covers Washington County, Utah.

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 Center 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

H2905_120928_204031 CMS Approved
Last update: 10/12

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