Medicare made simple.

Available to Ohio residents of: Ashtabula, Carroll, Columbiana, Cuyahoga, Erie, Geauga, Huron, Lake, Lorain, Mahoning, Medina, Portage, Sandusky, Stark, Summit, Trumbull, Tuscarawas and Wayne counties.

S U M M A C A R E S E C U R E E N R O L L M E N T G U I D E

M E D I C A R E A D V A N T A G E P L A N W I T H P R E S C R I P T I O N D R U G S ( M A P D )

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H3660_11_04 CMS Approved 07072010

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Thank you for your interest in SummaCare Secure and welcome to the 2011 SummaCare Secure Enrollment Guide! This all-in-one booklet will walk you through all of the important information you need to know before choosing one of our Medicare Advantage Plans with Prescription Drugs (MAPD).

Here’s what to do:

STEP 1: Review our medical and pharmacy benefits in TABS 1 through 3. Tab 1 includes details about our Core (HMO) plan. TAB 2 includes details about our Silver (HMO-POS) and Gold (HMO-POS) plans. TAB 3 includes a partial listing of the prescription drugs that are covered under these plans.

STEP 2: Review our listing of SCSecure hospitals and doctors in TAB 4 – “Provider Network.”

STEP 3: Complete and submit your application materials in TAB 5 – “How to Enroll.”

While all of the plans we offer include outstanding benefits and Customer Service, it is important that you choose the plan that meets your specific needs. That’s why we have knowledgeable staff members who will answer any questions you may have and provide you with the information you need to make the most of your Medicare dollar.

We also offer FREE seminars called “TalkAbout” meetings where one of our representatives can speak with you in person. To speak with one of our Medicare experts or for more information about our TalkAbout meeting schedule, please call us at 330-996-8440 or (toll free) 888-464-8440. Persons with hearing impairments, please call TTY at 800-750-0750.* For more information about Medicare benefits and services including general information regarding health or Part D benefits, you may also contact Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. You may also visit http://www.medicare.gov for more information.

We look forward to serving you!

Dear Medicare Beneficiary,

Sincerely,

James R. LovelessVice President of Individual ProductsSummaCare

*From November 15, 2010, through March 1, 2011, a representative will be available to speak with you from 8 a.m. to 8 p.m. seven days a week. Beginning March 2, 2011, through October 14, 2011, a representative will be available to speak with you from 8 a.m. to 8 p.m. Monday through Friday. You may also visit us online at www.medicare.summacare.com. Our mailing address is: SummaCare, 10 North Main Street, Akron, OH 44308.

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Introduction

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This Enrollment Guide includes information about the different MAPD plans we offer:

• If you are interested in overall cost savings, consider our HMO plan: SummaCare Secure Core (HMO) offers coverage through doctors and hospitals that are part of our SCSecure network. NOTE: You must receive care through in-network providers as a member of this plan (except for in emergency and urgent care situations).

• If you would like the freedom of choice combined with affordable plan options, consider our HMO-POS plans: SummaCare Secure Silver (HMO-POS) and SummaCare Secure Gold (HMO-POS) offer coverage through doctors and hospitals that are part of our SCSecure network IN ADDITION to coverage through any Medicare-approved doctor or hospital outside of our network.

In addition to medical coverage, ALL of the MAPD plans listed above also include coverage for Prescription Drugs.

About our Plans:

The SummaCare Secure Core (HMO) plan is a traditional HMO (Health Maintenance Organization) plan that offers comprehensive benefits and lower out-of-pocket costs than you get with Original Medicare alone. As a member of the SummaCare Secure Core (HMO) plan, you select a Primary Care Physician (PCP) who serves as your primary doctor by coordinating your medical care. All covered services such as hospitalization, office visits, physicals, diagnostic tests and x-rays are covered at affordable, predictable costs. Part D prescription drug coverage is also included.

Key points about the SummaCare Secure Core (HMO) plan:• You will experience cost savings with a $0 monthly plan premium• Your coverage will include preventive care services such as immunizations and a routine physical at no cost to you• You will experience predictable and affordable expenses for doctor visits and diagnostic tests such as x-rays• You are required to choose SCSecure network providers (except in emergency or urgent care situations). The SCSecure network includes thousands of providers

and many of the area’s finest hospitals• Your medical care will be coordinated by the Primary Care Physician (PCP) you select from the SCSecure provider network The SummaCare Secure Silver (HMO-POS) and SummaCare Secure Gold (HMO-POS) plans are HMO plans WITH a POS (Point of Service) option included. This means that you will have the freedom to choose any Medicare-approved doctor or hospital you wish. While you have the option to choose any Medicare-approved provider, keep in mind that you may have to pay more for the services you receive outside of the SCSecure network. Part D prescription drug coverage is also included.

Introduction

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Key points about the SummaCare Secure Silver (HMO-POS) and SummaCare Secure Gold (HMO-POS) plans:

• Your coverage will include preventive care services such as immunizations and a routine physical at no cost to you• You will experience predictable and affordable expenses for doctor visits and diagnostic tests such as x-rays• You will have the freedom to choose any Medicare-approved provider you wish• You will save money by choosing a SCSecure network provider. (The SCSecure network includes thousands of providers and many of the areas finest hospitals)

Frequently Asked Questions:

What is a Medicare Advantage Plan?Medicare Advantage Plans, like those offered by SummaCare, provide an alternative way for Medicare beneficiaries to receive their health care benefits. Medicare Advantage plans provide richer benefits than Original Medicare Part A (inpatient hospital benefits) and Medicare Part B (outpatient health care benefits) alone.

Do I keep my Medicare benefits when I join a SummaCare Secure Medicare Advantage Plan?YES. When you enroll in a Medicare Advantage Plan, you are still in Medicare. You continue to receive all of your Medicare Part A and B benefits, PLUS additional benefits and services provided by SummaCare. However, you will present your SummaCare Secure Member ID card instead of your Medicare red, white and blue card when you access providers.

Does SummaCare offer other Medicare options in addition to MAPD plans?YES. We offer:• SummaCare Secure Classic (HMO-POS): Designed for Medicare beneficiaries who are interested in overall cost savings but do NOT need prescription drug

coverage.

• SummaCare Secure Scripts 1 (PDP) and SummaCare Secure Scripts 2 (PDP): These are Prescription Drug Plan options for Medicare beneficiaries who ONLY need Medicare Part D (prescription drug) coverage.

• SummaCare Supplemental Solutions: Also known as “Medigap” plans, these options are for Medicare beneficiaries who want the flexibility of choosing any Medicare-approved doctor or hospital with minimal out-of-pocket costs.

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Why is SummaCare Secure a smart choice for me?SummaCare has been serving Medicare beneficiaries in Northern Ohio since 1996 and now has more than 20,000 members in 18 Ohio counties.

• Since 2001, SummaCare has been awarded the highest accreditation of “Excellent” by the National Committee for Quality Assurance (NCQA).*

*NCQA accreditation for HMO/POS and Medicare products in 2001, 2004 and 2007 and HMO/POS, Medicare and Commercial PPO in 2010.

• SummaCare Secure is the only Medicare Advantage plan in the state’s Eastern region to receive a 5-star rating from the Centers for Medicare and Medicaid Services (CMS) in their annual Medicare and You publication.** **Medicare and You 5-star rating in 2008, 2009 and 2010.

• SummaCare is consistently rated one of America’s Best Health Plans by U.S.News & World Report/NCQA and our Medicare plan was the top-rated health plan in Ohio in 2009.***

***U.S.News & World Report/NCQA America’s Best Health Plans in 2005, 2006, 2007, 2008 and 2009.

• SummaCare is the only plan recognized in Ohio by the Health Industries Research Company as the health plan with the Most Effective Disease Management Programs for Asthma, Heart Failure and Diabetes.****

****Health Industries Research Company recognition in 2007-2010.

Introduction

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About UsSummaCare, Inc. was established in 1993 and is based in Akron, Ohio. SummaCare is a provider-owned insurance company – developed by doctors, for patients. SummaCare contracted with the Centers for Medicare and Medicaid Services (CMS) in 1996 to become a health care option for Medicare recipients.

Today, the SummaCare Secure service area spans 18 counties in Northeast Ohio. To enroll in SummaCare Secure, you must live in one of these counties.

Our motto is “Medicare Made Simple” – this means:

• Medical and pharmacy coverage in one plan

• Virtually no paperwork

• Knowledgeable Medicare experts who are just a phone call away

You don’t have to give up Medicare to get ANY of the rich benefits and services that SummaCare Secure plans provide. Medicare pays us a monthly fee when you join our plan. In exchange, we work with our carefully selected doctors and hospitals to make sure you receive the care you need.

Who Can Enroll? You qualify for SummaCare Secure if:

1. you are entitled to Medicare Part A and are enrolled in Medicare Part B;

2. you live in our service area (Ashtabula, Carroll, Columbiana, Cuyahoga, Erie, Geauga, Huron, Lake, Lorain, Mahoning, Medina, Portage, Sandusky, Stark, Summit, Trumbull, Tuscarawas or Wayne counties);

3. you do not have end stage renal disease. If you are already covered by SummaCare and you have end stage renal disease, you are eligible for this plan.

You can enroll without having to complete a physical. You cannot be turned down or canceled because of illness.

SummaCare Secure Service Area

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Confidentiality You may access your SummaCare claims information by visiting www.medicare.summacare.com and logging into SummaCare Plan Central or by contacting Customer Service. You may only access your own personal information. For example, if your spouse is also enrolled in SummaCare, you may not have access to his/her claims information. If you would like medical records from a provider, please contact the provider’s office for information on how to obtain these records. Your personal health information is subject to strict internal confidentiality guidelines including the use of security passwords and signed confidentiality agreements for both employees and contracted vendors.

Prior-Authorization Your SCSecure Primary Care Physician is responsible for obtaining any required prior-authorization from SummaCare.

Prior-authorization is required for certain services to ensure that the service is medically appropriate and that you receive all the benefits you are entitled to. SummaCare uses nationally accepted criteria when reviewing a service for prior-authorization. If it is determined that a service is not medically appropriate, you and your provider will receive a letter stating how to initiate an appeal if you disagree with the decision.

If you have the SummaCare Secure Silver (HMO-POS) or SummaCare Secure Gold (HMO-POS) plan and choose to receive care from an out-of-network provider, you are responsible for obtaining any necessary prior-authorization from SummaCare. You can do this by calling SummaCare’s Prior Authorization Department at 888-996-8710. Someone will be available to speak with you from 8 a.m. until 5 p.m. Monday through Friday. The Summary of Benefits found in Tab 1 and Tab 2, lists services which require prior-authorization. If proper prior-authorization is not obtained before services are received, these services may not be covered under your plan.

Introduction

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Extra Benefits! At SummaCare, the health and wellness of our members is important to us. That’s why we offer programs and discounts to help our members stay well and feel their best.

These include the following FREE services:

• 24-Hour Nurse Line: SummaCare’s 24-Hour Nurse Line is like having a private nurse right at your fingertips. If you are sick or injured and you’re just not sure what to do, you can call and talk to a registered nurse.

• Disease Management Programs: SummaCare’s disease management programs provide specialized services to members who have been diagnosed with certain diseases. Programs include HeartCare, AsthmaCare, DepressionCare and DiabetesCare. SummaCare Secure members who participate learn tips and techniques to manage symptoms, take control of their health and achieve a better quality of life.

• WebMD: SummaCare Secure members can get a personalized health risk assessment online via WebMD. The WebMD tool also includes educational videos, access to create your own personal health record and other health topics available in the online encyclopedia.

• Case Management Program: SummaCare’s Case Management program assists members who have been diagnosed with complex health problems. A SummaCare nurse, called a Care Coordinator, monitors members’ clinical care, assists with transitions between the hospital and home or other care settings and helps SummaCare members find the health and support services they may need.

SummaCare is the only plan recognized in Ohio by the Health Industries Research Company as the health plan with the Most Effective Disease Management Programs for Asthma, Heart Failure and Diabetes.*

For information on these and more Health & Wellness Services provided to SummaCare Secure members, please visit www.medicare.summacare.com.

*Health Industries Research Company recognition in 2007-2010.

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Introduction

EyeMed Vision Discount Program Our vision discount program through EyeMed Vision Care provides SummaCare Secure members with a comprehensive eye exam at a discount and approximately 40% off complete pairs of glasses at participating locations including LensCrafters, Pearle Vision and Sears Optical. To receive your discount, simply present your SummaCare Secure Member ID Card. The EyeMed Vision Discount Program is not insurance. EyeMed Vision Care discounts do not replace your current medical (vision) benefits through SummaCare Secure. You are still entitled to receive one eye exam every 12 months subject to your SummaCare Secure plan’s applicable co-pay. Your EyeMed Vision Discount cannot be combined with any other discounts, coupons or promotional offers. For more information or to locate EyeMed Vision Discount Program providers, call 1-866-688-4699 or visit www.eyemedvisioncare.com.

Emergency Coverage – Worldwide

If you have a medical emergency, you still qualify for coverage even if you can’t get to one of our SCSecure hospitals. If you need emergency treatment anywhere in the world, go to the nearest hospital or urgent care center. We recommend you contact your Primary Care Physician within 48 hours so that he/she can coordinate any follow-up care.

Extra Benefits! (continued)