Below, please find Ultimate Health Plans’ most accessed documents and forms. If you can’t find what you’re looking for or if you need help, please call Member Services at 1-888-657-4170(TTY 711) and we’ll be happy to assist you.
PDF documents can be downloaded and then viewed with Adobe Reader. here.
The Evidence of Coverage(EOC) booklet tells you how to get your Medicare medical care and prescription drugs covered through our plan. This booklet explains your rights and responsibilities, what is covered, and what you pay as a member of the plan. Chapter 4 of the EOC focuses on your covered services and what you pay for your medical benefits. It includes a Medical Benefits Chart that lists your covered services and shows how much you will pay for each covered service as a member of Ultimate Health Plans. It also has information about medical services that are not covered and explains limits on certain services.
Evidence of Coverage
Advantage Plus by Ultimate (Full) (035), Citrus
Advantage Plus by Ultimate (Full) (037), Hernando and Pasco
Advantage Plus by Ultimate (Full) (039), Hillsborough and Pinellas
Advantage Plus by Ultimate (Full) (041), Lake, Marion and Sumter
Advantage Plus by Ultimate (Full) (043), Indian River and St. Lucie
Evidence of Coverage
Advantage Plus by Ultimate (Partial) (036), Citrus
Advantage Plus by Ultimate (Partial) (038), Hernando and Pasco
Advantage Plus by Ultimate (Partial) (040), Hillsborough and Pinellas
Advantage Plus by Ultimate (Partial) (042), Lake, Marion and Sumter
Advantage Plus by Ultimate (Partial) (044), Indian River and St. Lucie
The Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of our benefits, please access the “Evidence of Coverage” document above.
Summary of Benefits
Advantage Plus by Ultimate (Full) (035, 037, 039, 041, 043), Citrus, Hernando, Pasco, Hillsborough, Pinellas, Lake, Marion, Sumter, Indian River, and St. Lucie counties
Advantage Plus by Ultimate (Partial) (036, 038, 040, 042, 044), Citrus, Hernando, Pasco, Hillsborough, Pinellas, Lake, Marion, Sumter, Indian River, and St. Lucie counties
Ultimate Health Plans maintains a Quality Program to improve quality of care and member health outcomes. The Quality Program provides the framework for how we monitor the quality of care and services that our members receive. Through this program, we develop clinical initiatives and process improvements. On an annual basis, Ultimate Health Plans measures the program's effectiveness on an annual basis.
Ultimate Health Plans analyzes many different types of data, including member clinical data (such as claims, lab results, and diagnoses) as well as member and provider appeals and grievances. Ultimate Health Plans also monitors its internal processes.
Ultimate Health Plans annually measures the quality of care and services its members receive through the use of the Healthcare Effectiveness Data and Information Set (HEDIS®). Ultimate Health Plans also conducts annual member surveys to determine what members think about the health plan, their physicians, and their own health. This survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We also look at member responses to the Medicare Health Outcomes Survey (HOS), which tells us how its members feel about their health.
Ultimate Health Plans also monitors measures of patient safety on an annual basis. Ultimate Health plans maintain programs to improve patient safety, such as through medication reconciliation and the use of high-risk medications.
Ultimate Health Plans uses the Quality Program to implement ongoing, continuous quality improvement projects and interventions. Examples of quality projects may include:
One of the ways that you can determine how well we are doing is by looking at our Medicare Star Rating. Every year, Medicare evaluates plans based on a 5-star rating system. This system is based on the health plan’s quality and performance. You can find information about our current star rating below.
Medicare Star Ratings - English
The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star Ratings help you know how good a job our plan is doing. You can use these Star Ratings to compare our plan's performance to other plans. Click on this document to view our current Star Rating.
Calificaciones por estrellas Medicare - Spanish
Ultimate Health Plans is evaluated by the National Committee for Quality AYou can review our report card by visiting ssurance (NCQA) every three years. https://reportcards.ncqa.org/health-plan/Hp_3_1_001G000001uwtBdIAI_1550
Ultimate Health Plans also establishes internal goals and benchmarks in an annual quality work plan. Quality monitoring information is reported to the Quality Management Steering Committee. This committee reports to the Ultimate Health Plans Board of Directors.
For more information about this program, please contact Member Services at 1-888-657-4170 (TTY 711)..
Some services are covered by our plan only if your Primary Care Physician (PCP) or other provider gets permission from Ultimate Health Plans first. This is called a Prior Authorization.
Ultimate Health Plans has a formal process to evaluate and address new developments in technology and new applications of existing technology. We consider including new technology in our benefit plans to keep pace with changes and to ensure our members have equitable access to safe and effective care. To learn more about this formal process, please open the document below.
You can appoint someone to represent you in formal matters, such as appeals or grievances, by completing the form below:
Use this form if you want Ultimate Health Plans to share the information we have about you with another person or organization, such as a family member, friend, or another relative; someone who helps take care of you; and social worker or healthcare advocacy group.
If you're a new member, help us better understand your health needs and transition your care by completing and returning the form below.
You must submit your claim to us within 12 months of the date you received the service, item, or drug.
Every competent adult has the right to make decisions concerning his or her own health, including the right to choose or refuse medical treatment. When a person becomes unable to make decisions due to a physical or mental change, such as being in a coma or developing dementia (like Alzheimer’s disease), they are considered incapacitated. To make sure that an incapacitated person’s decisions about health care will still be respected, the Florida legislature enacted legislation pertaining to health care advance directives (Chapter 765, Florida Statutes). The law recognizes the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures; to designate another individual to make treatment decisions if the person becomes unable to make his or her own decisions; and/or to indicate the desire to make an anatomical donation after death.
Medicare law gives you the right to file a complaint with the Agency for Health Care Administration (AHCA) if you are dissatisfied with our process for handling Advance Directives.
To complete an Advance Directives, simply download the information and complete the forms in the document below. Make sure that your primary care doctor, attorney and the significant persons in your life know that you have an Advance Directives, and give them a copy. You may also want to keep a card or note in your purse or wallet that states that you have an Advance Directives and where it is located.
If you change your Advance Directives, make sure your health care provider, attorney, and the significant persons in your life have the latest copy. To download Advance Directives information and forms, please click on the following link.
If there is an emergency, do you know:
These Preventive Care Guidelines address routine health exams, diagnostic checkups, counseling and immunizations recommended for adults. Discuss these general guidelines with your doctor to stay as healthy as possible throughout the year.
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