2024 H3256 001 04 - local ppo

8 a.m. – 8 p.m. local time, ... UHC Dual Complete GA-S001 (PPO D-SNP) H3256-001-000 CMS Rating 4.5 out of 5 stars. Food, OTC and Utilities $169 credit every month to pay for healthy food, OTC products and utility bills Dental benefits $3000 allowance for covered preventive and comprehensive dental services ... 04.18.2024 at 12:11 AM CDT.. Publix warehouse dacula

AETNA Summary of Benefits - Local Plan (PPO) - 2021. Download File. Use the print buttons in the Preview. To properly print this document, hover your mouse over the document PREVIEW area and controls will appear. There you can DOWNLOAD or PRINT this document. Email Doc. Date Posted. 11/01/2019.UHC Dual Complete GA-S001 (PPO D-SNP) H3256-001 Plan Details. 4 out of 5 stars. UHC Dual Complete GA-S001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare ... Plan ID: H3256-001. Have Medicare questions? Talk to a licensed agent today to find a plan that fits your needs. Get Medicare Help $ 0.00.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ...Specialty Doctor Visit. $35 in-network | $50 out-of-network. Inpatient Hospital Care. $250 per day, days 1-5; $0 per day, days 6-90 in-network | 30% per stay out-of-network. Urgent Care. Copayment for Urgent Care $35.00. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110.00. Emergency Room Visit.UnitedHealthcare Dual Complete® Choice Select LP (PPO D-SNP) H3256-002-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-855-545-9340, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCMedicareSolutions.comOut-of-Network: 35% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $40.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00. Maximum Plan Benefit of $50,000. Emergency Room Visit.4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-001-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Wellcare No Premium Open (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $200 (Tier 1, 2 and 6 excluded from the Deductible.)UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000 ... Plus, you have the flexibility to access a network of local providers. You may pay a higher ...Benefits. In-Network. Out-of-Network. Inpatient Hospital Care 2. $325 copay per day: days 1-6 $0 copay per day: days 7 and beyond. $495 copay per day: for days 1 …UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) Location: Gordon, Georgia Click to see other locations: Plan ID: H3256 - 002 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact ...Premium: $32.30. Enroll Now. This page features plan details for 2023 UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) H3256 – 002 – 0 available in Select Counties for Georgia. IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below: 2024 UHC Dual Complete GA-V001 (PPO D …This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership and Plan Ratings: The UnitedHealthcare Dual Complete Choice LP (PPO D … UnitedHealthcare offers UHC Dual Complete GA-S001 (PPO D-SNP) plans for Georgia and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. 4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-V001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-002-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Humana USAA Honor (PPO) 4.5 out of 5 stars* for plan year 2024. Humana USAA Honor (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-348-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. This is a summary of drug and health services covered by Wellcare Giveback (HMO), Wellcare No Premium (HMO) and Wellcare Assist (HMO) from January 1, 2023 to December 31, 2023. This booklet will provide you with a summary of what we cover and the cost-sharing responsibilities. It does not list every service, limitation, or exclusion.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Amerivantage Choice (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $15.00 (see Plan Premium Details below) Annual Deductible: $0. Annual Initial Coverage Limit (ICL):UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000 plans for Georgia and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2021 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, Inc Out-of-Network: 35% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $40.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Companies that offer Georgia Insurance Company Medicare Advantage with Part D. Aetna Medicare. Anthem Blue Cross and Blue Shield. BlueCross BlueShield of Tennessee. CareSource. Cigna Healthcare ... 2024. H1112-039. Wellcare No Premium (HMO) 2024. H1112-044. Wellcare No Premium Value (HMO-POS) 2024. H1416-082. Discover Medicare insurance plans accepted at our Augusta health center and find primary care doctors accepting Medicare near you.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Allina Health Aetna Medicare Plus (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $250 (Tier 1 and 2 excluded from the Deductible.) UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) Location: Stephens, Georgia Click to see other locations: Plan ID: H3256 - 001 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: Benefits. In-Network. Out-of-Network. Inpatient Hospital Care 2. $325 copay per day: days 1-6 $0 copay per day: days 7 and beyond. $495 copay per day: for days 1-10 $0 copay per day: for days 11 and beyond. Inpatient Hospital Care 2. Our plan covers an unlimited number of days for an inpatient hospital stay. Outpatient Hospital.Specialty Doctor Visit. $35 in-network | 50% out-of-network. Inpatient Hospital Care. $335 per day, days 1-6; $0 per day, days 7-90 in-network | 50% per stay out-of-network. Urgent Care. Copayment for Urgent Care $55.00. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00. Emergency Room Visit.2024. H1112-044. Wellcare No Premium Value (HMO-POS) 2024. H1416-082. 4.66. 7028 Hwy 85, Riverdale, GA 30274. Discover Medicare insurance plans accepted at our Riverdale health center and find primary care doctors accepting Medicare near you.2024 UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) - H3256-001-0 in GA Plan Benefits DetailsPPO) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $49 Annual Medical Deductible This plan does not have a deductible. Maximum Out-of-Pocket Amount (does not include prescription drugs) $6,700 annually for Medicare-covered services you receive from any provider. If you reach the limit on out-of-pocket costs, you keepHumana USAA Honor (PPO) 4.5 out of 5 stars* for plan year 2024. Humana USAA Honor (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-348-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.This page features plan details for 2024 UHC Dual Complete GA-V001 (PPO D-SNP) H3256 – 002 – 0 available in Select Counties in Georgia. IMPORTANT : This page has been updated with plan and premium data for 2024.UHC Dual Complete RI-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H0764-001-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on …UHC Dual Complete RI-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H0764-001-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on …UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) Location: Emanuel, Georgia Click to see other locations: Plan ID: H3256 - 001 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information:Plan Overview. UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) offers the following coverage and cost-sharing. Please Note: This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.The following Medicare Advantage plan benefits apply to the Medicare Plus Blue PPO Essential (PPO) (H9572 - 004) in Barry, Michigan . ... This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership and Plan Ratings: The Medicare Plus Blue PPO Essential (PPO) (H9572 - 004) currently has 47,608 members. ...2021 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, IncCompanies that offer Georgia Insurance Company Medicare Advantage with Part D. Aetna Medicare. Anthem Blue Cross and Blue Shield. BlueCross BlueShield of Tennessee. CareSource. Cigna Healthcare ...2021 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, IncPlan Overview. UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) offers the following coverage and cost-sharing. Please Note: This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $100.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $100.00. Maximum Plan Benefit of $50,000.2021 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, IncCompanies that offer Georgia Insurance Company Medicare Advantage with Part D. Aetna Medicare. Anthem Blue Cross and Blue Shield. BlueCross BlueShield of Tennessee. CareSource. Cigna Healthcare ...Here s how this PPO D-SNP p lan work s Select a primary care provider to oversee and help manage your care. You re not limited to this PCP, but it s beneficial for your long term health and well-being. $0 covered services when received in-network . See the Summary of Benefits in this book to find out what services are covered .4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-001-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.2022 UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) - H3256-001-0 in GA Plan Benefits ExplainedUnitedHealthcare Dual Complete® Choice Select LP (PPO D-SNP) H3256-002-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-855-545-9340, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCMedicareSolutions.comAlthough health maintenance organizations (HMOs) and preferred provider organizations (PPOs) represent the majority of insurance plans currently available, some employers and insur...2022 UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) - H3256-001-0 in GA Plan Benefits Explained4.5 out of 5 stars* for plan year 2024. HumanaChoice H5216-316 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H5216-316-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $28.00 Monthly Premium.Page 1 of 8 2024 Enrollment Request Form o UHC Dual Complete GA-S001 (PPO D-SNP) H3256-001-000 - B76 Information about you (Please type or print in black or blue ink) Last name First name Middle initial Birth date Sex ¨ Male ¨ Female UnitedHealthcare Senior Care Options (HMO SNP) plan. UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership and Plan Ratings: The HumanaChoice H5970-001 (PPO) (H5970 - 001) currently has 3,746 members. There are 231 members enrolled in …UnitedHealthcare Dual Complete plans. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare.2024. H1112-039. Wellcare No Premium (HMO) 2024. H1112-044. Wellcare No Premium Value (HMO-POS) 2024. H1416-082. Discover Medicare insurance plans accepted at our Augusta health center and find primary care doctors accepting Medicare near you.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Wellcare No Premium Open (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $200 (Tier 1, 2 and 6 excluded from the Deductible.)H3256-001 -000. Monthly premium: $ 0.00 *. *Your costs may be as low as $0, depending on your level of Extra Help. This Preferred Provider Organization (PPO) plan gives you …This question is about the Discover it® Cash Back @dooleyricardo2 • 04/15/22 This answer was first published on 08/15/19 and it was last updated on 04/15/22.For the most current in...Here s how this PPO D-SNP p lan work s Select a primary care provider to oversee and help manage your care. You re not limited to this PCP, but it s beneficial for your long term health and well-being. $0 covered services when received in-network . See the Summary of Benefits in this book to find out what services are covered .H3256-001 -000. Monthly premium: $ 0.00 *. *Your costs may be as low as $0, depending on your level of Extra Help. This Preferred Provider Organization (PPO) plan gives you …UnitedHealthcare offers UHC Dual Complete GA-S001 (PPO D-SNP) plans for Georgia and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.UnitedHealthcare® Medicare Silver (Regional PPO C-SNP) is a Chronic or Disabling Condition Special Needs Plan designed to specifically help people who have one or more of the following conditions: Cardiovascular Disorders, Chronic Heart Failure, and Diabetes. Our service area includes Georgia, and South Carolina. Use network providers and ...UnitedHealthcare Dual Complete plans. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the AARP Medicare Advantage Mosaic Choice (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 (see Plan Premium Details below) Annual Deductible: $250 (Tier 1 and 2 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $100.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $100.00. Maximum Plan Benefit of $50,000.UHC Dual Complete GA-S001 (PPO D-SNP) 4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare …2024. H4624-028. Zing Medicare-Medicaid Plan IL (MMP) (Medicare-Medicaid Plan) 2024. H7539-001. Zing Select Diabetes & Heart Complete IL (HMO C-SNP) 2024. H4624-027. Discover Medicare insurance plans accepted at our Garfield Ridge health center and find primary care doctors accepting Medicare near you. o UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000 - UD8 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000 ... Plus, you have the flexibility to access a network of local providers. You may pay a higher ... Out-of-Network: 40% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $0.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $135.00. Maximum Plan Benefit of $50,000. Emergency Room Visit.2021 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, IncFill H3256 001, Edit online. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. Try Now!UnitedHealthcare Senior Care Options (HMO SNP) plan. UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) Location: Early, Georgia Click to see other locations: Plan ID: H3256 - 002 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact ... coverage through our plan, HumanaChoice H0473-001 (PPO). We are required to cover all Part A and Part B services. However, cost sharing and provider access in this plan differ from Original Medicare. There are different types of Medicare health plans. HumanaChoice H0473-001 (PPO) is a Medicare Advantage PPO The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. We do not offer every plan available in your area. UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) Location: Gordon, Georgia Click to see other locations: Plan ID: H3256 - 002 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact ...UHC Dual Complete RI-S001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H0764-001-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

Premium: $32.30. Enroll Now. This page features plan details for 2023 UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) H3256 – 002 – 0 available in Select Counties for Georgia. IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below: 2024 UHC Dual Complete GA-V001 (PPO D-SNP) H3256 ... . Pinche maricon

1-866-480-1086. (TTY users should call 711). Hours are 8 a.m.-8 p.m. local time, 7 days a week. This plan, UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP), is insured through UnitedHealthcare Insurance Company or one of its affiliates. (When this Evidence of Coverage says “we,” “us,” or “our,” it means UnitedHealthcare. This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan. Plan Membership. The UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) (H3256 - …1-866-480-1086. (TTY users should call 711). Hours are 8 a.m.-8 p.m. local time, 7 days a week. This plan, UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP), is insured through UnitedHealthcare Insurance Company or one of its affiliates. (When this Evidence of Coverage says “we,” “us,” or “our,” it means UnitedHealthcare. 4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-V001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-002-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. 2024. H1112-044. Wellcare No Premium Value (HMO-POS) 2024. H1416-082. 4.66. 7028 Hwy 85, Riverdale, GA 30274. Discover Medicare insurance plans accepted at our Riverdale health center and find primary care doctors accepting Medicare near you.UHC Dual Complete GA-S001 (PPO D-SNP) H3256-001-000. Look inside to learn more about the plan and the health and drug services it covers. Call Customer …UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000. Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Page 1 of 8 2024 Enrollment Request Form o UHC Dual Complete GA-S001 (PPO D-SNP) H3256-001-000 - B76 Information about you (Please type or print in black or blue ink) Last name First name Middle initialUnitedHealthcare Medicare Advantage Choice (Regional PPO) 2024: R2604-001: UHC Complete Care GS-001A (Regional PPO C-SNP) 2024: R2604-002: UHC Complete Care GS-0002 (Regional PPO C-SNP) 2024: R2604-003: UnitedHealthcare Medicare Advantage Patriot (Regional PPO) 2024: R2604-005: UHC Dual Complete GA-S001 (PPO D-SNP) 2024: H3256-001: UHC Dual ... 4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-V001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-002-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. UnitedHealthcare Dual Complete® Choice LP (PPO D-SNP) H3256-001-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-855-545-9340, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCMedicareSolutions.comCopayment for Medicare Covered Physician Specialist Office Visit $50.00. Inpatient Hospital Care. In-Network: Acute Hospital Services: $300.00 per day for days 1 to 6. $0.00 per day for days 7 to 90. Prior Authorization Required for Acute Hospital Services. Prior authorization required. Out-of-Network:3.5 out of 5 stars* for plan year 2024. HumanaChoice H0473-004 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc. Plan ID: H0473-004-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. 4.5 out of 5 stars* for plan year 2024. UHC Dual Complete GA-V001 (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H3256-002-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. UHC Dual Complete GA-V001 (PPO D-SNP) H3256-002-000 Look inside to learn more about the plan and the health and drug services it covers. ... • Social activities at local health and wellness classes, clubs and events • Online Fitbit® Community for Renew Active — no Fitbit device needed.

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