2013 Senior Health Plan
Senior Health Plan
An Economical Plan for People With Medicare
CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. CommunityCare Senior Health Plan is a Federally-Qualified HMO with a Medicare contract and is owned by Saint Francis Health System and St. John Health System in Tulsa (other physicians and providers are available in our network). Senior Health Plan's contract with CMS is renewed annually. As a result, the availability of coverage beyond the end of the current contract year is not guaranteed. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.
Senior Health Plan has three Medicare Advantage Plans to fit the varying needs of Medicare beneficiaries for health coverage or Part D prescription drug coverage.
Select a Senior Health Plan product below to view more information including Evidence of Coverage, Summary of Benefits, Annual Notice of Change (ANOC), Premiums and more.
Fraud Awareness Alerts are issued by the Medicare Drug Integrity Contractor (MEDIC) as part of CMS's efforts to combat Medicare fraud, waste and abuse, and explain the latest fraud schemes and how to report suspected fraud.
Click the links below to find out more.
- Protect Against Tax Refund Fraud
- If you receive medical supplies that you or your doctor did not order, you might be the target of a fraud scheme.
- Report services or items that you have been billed for, but did not receive.
- Don't let anybody steal your identity.
- You can do your part by being on the look out for fraudulent schemes.
Senior Health Plan Service Areas
Although Medicare is a Federal program, Senior Health Plan is available only to individuals who live in our plan service area. To stay a member of our plan, you must keep living in this service area. The service area is described below:
Our service area includes these counties in Oklahoma: Creek, Rogers, Tulsa, and Wagoner Counties.
Our service area includes these parts of counties in Oklahoma: Osage County, (the following zip codes only):74002, 74035, 74054, 74060, 74063, 74070, 74084, 74126, and 74127; Washington County, (the following zip codes only): 74003, 74005, 74006, 74029, 74051, 74061, 74070.
If you plan to move out of the service area, please contact Member Services.
Everything You Need to Know About CommunityCare Senior Health Plan
Senior Health Plan seminars
Need more Information?
Please call our Member Services Department at 1-800-642-8065 if you have any questions. Member Services Representatives will be available Monday through Friday from 8:00 am to 8:00 pm, CST. From October 1, 2012 through February 14, 2013, Member Services hours will include Saturdays, Sundays and some Holidays. TTY/TDD users should call 1-800-722-0353.
If you like to contact Senior Health Plan via mail, please use the following address:
P.O. Box 3327
Tulsa, OK 74101-3327
You can also get information about the Medicare Program and Medicare health plans by visiting www.medicare.gov on the Web or by calling 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week, to answer questions about Medicare.
You are now able to file a complaint concerning your Medicare health plan or prescription drug plan directly to Medicare.
- Click here to access the Medicare Complaint Form.
- Click here to access the Ombudsman website on the Medicare.gov website to get help with complaints, grievances, and information request.
You may join or leave a plan only at certain times. Please call Senior Health Plan at the telephone number listed in the previous section of this web page or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048. You can call this number 24 hours a day, seven days a week.
You can join Senior Health Plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Senior Health Plan unless they are members of our organization and have been since their dialysis began.
Senior Health Plan has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or search the Senior Health Plan provider directory on this website. If you choose to go to a doctor outside of our network, you must pay these services yourself. Neither Senior Health Plan nor the Original Medicare Plan will pay for these services.
You must continue to pay your Medicare Part B premium, even if the Senior Health Plan premium is $0.
Senior Health Plan has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a current Pharmacy Network List or search the Senior Health Plan provider directory on this website.
As a member of Senior Health Plan, you have the right to request a coverage determination. When a coverage decision involves your medical care, it is called and "organization determination." A coverage determination includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered.
- Click here for Medicare Part D Coverage Decisions and Appeals
- Click here for a Summary of Medicare Part C and Part D Grievances, Coverage Decisions and Appeals (Platinum and Platinum Plus)
- Click here for a Summary of Medicare Part C Grievances, Coverage Decisions and Appeals (Silver)
- Click here for National Coverage Determination (NCD) notification
- Click here to initiate a Coverage Decision by sending an e-mail to PharmacyHelpDesk@ccok.com
Pending CMS Approval