2019 Plan Materials

(Coverage Year: January 01, 2019 to December 31, 2019) 

As a member of Banner – University Care Advantage (HMO SNP), you will find documents and links below to provide you with information related to your benefits and the health plan. Contact the plan if you need further assistance.


2019 Annual Notice of Changes

The Annual Notices of Changes (ANOC) booklet tells about the changes between plan benefit years 2018 and 2019. Please select your county below to review changes to plan benefits.

Annual Notice of Changes (ANOC) Booklets

Review this section if you have both Medicare and Medicaid (AHCCCS Complete Care)

COUNTY/SERVICE AREA  
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English Español

Review this section if you have both Medicare and Medicaid (Arizona Long Term Care System)

COUNTY/SERVICE AREA
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English Español

2019 Evidence of Coverage

This booklet gives you the details about your Medicare and Arizona Health Care Cost Containment System or AHCCCS (Medicaid) health care and prescription drug coverage from January 1, 2019 – December 31, 2019. It explains how to get coverage for the health care services and prescription drugs you need. This is an important legal document.

Evidence of Coverage Booklets

Review this section if you have both Medicare and Medicaid (AHCCCS Complete Care)

COUNTY / SERVICE AREA    
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English Español

Review this section if you have both Medicare and Medicaid (Arizona Long Term Care System)

 COUNTY / SERVICE AREA    
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English

Español


2019 Drug Formulary

(Coverage Year: January 01, 2019 to December 31, 2019)

The drug formulary contains information about the drugs we cover in this plan.

A drug formulary is a list of covered medications selected by Banner – University Care Advantage (HMO SNP) in consultation with a team of health care providers. The drug formulary represents the prescription therapies believed to be a necessary part of a quality treatment program. 

Our plan will usually cover the drugs listed in our formulary as long as the drug is medically necessary. The prescription is filled at a Banner – University Care Advantage network pharmacy, and other plan rules are followed.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or co-payments/co-insurance may change on January 1, 2019, and from time to time during the year.


Related Documents

Drug Formulary (Comprehensive)

(Updated 7/01/2019; Effective 8/01/2019)

English  Español
Prior Authorization Criteria 

(Updated 7/01/2019; Effective 8/01/2019)

English  
Step Therapy Criteria

(Updated 7/01/2019; Effective 8/01/2019)

 English  

Future Formulary Changes (May 2019)

(Updated 3/01/2019; Effective 5/01/2019)

English  

Future Formulary Changes (June 2019)

(Updated 4/01/2019; Effective 6/01/2019)

English  

Future Formulary Changes (July 2019)

(Updated 5/01/2019; Effective 7/01/2019)

English  
Future Formulary Changes (August 2019)

(Updated 6/01/2019; Effective 8/01/2019)

English  
Future Formulary Changes (September 2019)

(Updated 7/01/2019; Effective 9/01/2019)

English  
Future Formulary Changes (October 2019)

(Updated 8/01/2019; Effective 10/01/2019)

 English  

2019 Provider and Pharmacy Directories

You can find a network provider and/or pharmacy by using our online, searchable directories by using the links below. Our most current version of providers and pharmacies will always be updated online. 


To access the most recent version of providers, please use the links above. 

If you would like a Provider and/or Pharmacy Directory mailed to you, or if you need help finding a network provider and/or pharmacy, please call our Customer Care Center.


2019 Summary of Benefits

This is a summary of drug and health services covered by Banner – University Care Advantage (HMO SNP) January 1, 2019 to December 31, 2019. The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, see the “Evidence of Coverage.”

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium. The monthly Part B premium is paid for by State in some cases. Your cost-sharing is determined by your level of Medicaid eligibility.

Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Summary of Benefits Documents

Review this section if you have both Medicare and Medicaid (AHCCCS Complete Care)

COUNTY / SERVICE AREA
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English Español

Review this section if you have both Medicare and Medicaid (Arizona Long Term Care System)

COUNTY / SERVICE AREA
Cochise / Gila / Graham / Greenlee / La Paz English Español
Pima English Español
Maricopa / Pinal English Español
Santa Cruz / Yuma English

Español

 

 

H4931_Web_10152018 Pending