Erickson Medicare Advantage® Pre-Enrollment Disclaimer

This information is not a complete description of benefits. Benefits, features, and/or prices may vary by plan/area. Limitations, exclusions, and/or network restrictions may apply.

• Call 1-866-314-8188, TTY 711 for more information.
• Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.
• OTC benefits have expiration timeframes. Call your plan or review your Evidence of Coverage (EOC) for more information.
• The Giveback benefit is a reduction on your Medicare Part B premium.
• The fitness benefit includes a standard fitness membership. The information provided is for informational purposes only and is not medical advice. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. Gym network may vary in local market and plan.
• Other hearing exam providers are available in the UnitedHealthcare network. The plan only covers hearing aids from a UnitedHealthcare Hearing network provider. 
• If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market. 
• Routine transportation not for use in emergencies.  
• Annual routine eye exam and $100-500 allowance for contacts or 1 pair of frames, with standard (single, bi-focal, tri-focal, or standard progressive) lenses covered in full either every year or every two years. 
• $0 copay may be restricted to particular tiers, preferred medications, or home delivery prescriptions and may not apply across all coverage phases. 

• *Every year, Medicare evaluates plans based on a 5-star rating system. This five-out-of-five-star rating applies to contract number H5652 for the years 2021, 2022, 2023, and 2024.

Declaration of Disaster or Emergency

If you're affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

• Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
• Where applicable, requirements for gatekeeper referrals are waived in full;
• Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
• The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.
• If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

Call 1-866-314-8188, TTY: 711, for more information.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.