Sierra Health and Life Insurance Company, Inc.




	Enrollment Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices Eligibility Pre-Enrollment Information Enrollment Consultation Online Enrollment Payment Options Form Notice of Privacy Practices 2010 Plan Description 2010 Service Area 2010 Summary of Benefits 2010 Evidence of Coverage 2010 Service Area 2010 Summary of Benefits 2010 Evidence of Coverage 2010 Service Area 2010 Summary of Benefits 2010 Evidence of Coverage Sierra Spectrum Searchable Provider Directory Directorio de Proveedores del Plan (Pharmacy List and Provider Directory - Spanish) Prescriptions Formulary Deletions Change Update 2010 Formulary 2010 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Step Therapy Criteria 2010 Prior Authorization 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 Spectrum

Sierra Spectrum (PPO) is a Medicare Advantage Preferred Provider Organization plan that provides medical coverage and prescription coverage - in one plan.

To find out about Sierra Spectrum, call 1-877-289-0221; 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 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: 04/2010

H2905_41NVSHL09650R

Last update: 08/10