Evidence of Coverage
The Evidence of Coverage is a detailed explanation of the health and/or prescription drug benefits and services available to you. It includes information on how to use your coverage, details about your copays, a description of your member rights and responsibilities and a glossary of terms. Click on one of the links below to view the Evidence of Coverage document of your choice
Please note: Information about SummaCare Secure’s grievance, coverage determination (including exceptions) and appeals processes can be found in Chapter 9 of each of the documents below.
Medicare Advantage Prescription Drug (MAPD) Plans:
2012 Evidence of Coverage - Silver (HMO-POS)
2012 Evidence of Coverage - Gold (HMO-POS)
2012 Evidence of Coverage - Platinum (HMO-POS)
2012 Evidence of Coverage - Core (HMO)
2011 Evidence of Coverage – Silver (HMO-POS)
2011 Evidence of Coverage – Gold (HMO-POS)
2011 Evidence of Coverage – Platinum (HMO-POS)
2011 Evidence of Coverage – Core (HMO)
Medicare Advantage (MA) Plan:
2012 Evidence of Coverage - Classic (HMO-POS)
2011 Evidence of Coverage – Classic (HMO-POS)