***COVID-19*** There is an Emergency Declaration in place for
the State of Florida and Nationally. We are here for you.
Please click here to learn how Ultimate Health Plans provides benefits during an Emergency.
Welcome to Ultimate Health Plans. Below, please find frequently referenced plan documents.
Evidence of Coverage
The Evidence of Coverage 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.
The PDF documents can be downloaded and then viewed with Adobe Reader.
- Evidence of Coverage
Premier by Ultimate (001), Hernando
Premier by Ultimate (013-3), Pasco
-
Evidence of Coverage - English
Premier by Ultimate (011), Hillsborough and Pinellas
Evidencia de cobertura - SpanishPremier de Ultimate (011), Hillsborough y Pinellas
- Evidence of Coverage
Premier by Ultimate (013-4), Citrus
- Evidence of Coverage
Premier by Ultimate (028), Lake, Marion and Sumter
- Evidence of Coverage - English
Premier by Ultimate (031), Indian River and St. Lucie
Evidencia de cobertura - SpanishPremier de Ultimate (031), Indian River y St. Lucie
- Evidence of Coverage - English
Premier Plus by Ultimate (012), Hillsborough and Pinellas
Premier Plus by Ultimate (014-1), Hernando and Pasco
Premier Plus by Ultimate (032), Indian River and St. Lucie
Evidencia de cobertura - SpanishPremier de Ultimate (012), Hillsborough y Pinellas
Premier Plus de Ultimate (014-1), Hernando y Pasco
Premier Plus de Ultimate (032), Indian River y St. Lucie
- Evidence of Coverage
Premier Plus by Ultimate (014-2), Citrus
- Evidence of Coverage
Premier Plus by Ultimate (016), Lake, Marion and Sumter
- Evidence of Coverage
Advantage Care by Ultimate (019-1), Hernando
Advantage Care by Ultimate (019-2), Pasco
- Evidence of Coverage
Advantage Care by Ultimate (021), Citrus
- Evidence of Coverage - English
Advantage Care by Ultimate (026), Hillsborough and Pinellas
Advantage Care by Ultimate (029), Lake, Marion and Sumter
Evidencia de cobertura - SpanishAdvantage Care de Ultimate (026), Hillsborough y Pinellas
Advantage Care de Ultimate (029), Lake, Marion y Sumter
- Evidence of Coverage - English
Advantage Care by Ultimate (033), Indian River and St. Lucie
Evidencia de cobertura - SpanishAdvantage Care de Ultimate (033), Indian River y St. Lucie
- Evidence of Coverage
Advantage Care CHF by Ultimate (022), Citrus
- Evidence of Coverage
Advantage Care CHF by Ultimate (024), Hernando and Pasco
- Evidence of Coverage
Advantage Care COPD by Ultimate (023), Citrus
- Evidence of Coverage
Advantage Care COPd by Ultimate (025), Hernando and Pasco
- Evidence of Coverage - English
Advantage Care COPD by Ultimate (027), Hillsborough and Pinellas
Evidencia de cobertura - SpanishAdvantage Care COPD de Ultimate (027), Hillsborough y Pinellas
- Evidence of Coverage
Advantage Care COPd by Ultimate (030), Lake, Marion and Sumter
- Evidence of Coverage - English
Advantage Care COPD by Ultimate (034), Indian River and St. Lucie
Evidencia de cobertura - SpanishAdvantage Care COPD de Ultimate (034), Indian River y St. Lucie
Annual Notice of Change
Summary of Benefits
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
Premier by Ultimate (001, 011, 013 and 028)
Premier Plus by Ultimate (012, 014, 016)
Resumen de Beneficios - Spanish
Premier de Ultimate (001, 011, 013 and 028)
Premier Plus de Ultimate (012, 014, 016)
- Summary of Benefits - English
Advantage Care by Ultimate (019, 021, 026 and 029)
Advantage Care COPD by Ultimate (023, 025, 027 and 030)
Advantage Care CHF by Ultimate (022 and 024)
Resumen de Beneficios - Spanish
Advantage Care de Ultimate (019, 021, 026 and 029)
Advantage Care COPD de Ultimate (023, 025, 027 and 030)
Advantage Care CHF de Ultimate (022 and 024)
- Summary of Benefits - English
Premier by Ultimate (031)
Premier Plus by Ultimate by Ultimate (032)
Resumen de Beneficios - Spanish
Premier de Ultimate (031)
Premier Plus de Ultimate by Ultimate (032)
- Summary of Benefits - English
Advantage Care by Ultimate (033)
Advantage Care COPD by Ultimate (034)
Resumen de Beneficios - Spanish
Advantage Care de Ultimate (033)
Advantage Care COPD de Ultimate (034)
- Medicare Star Ratings - EnglishThe 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 2021 - Spanish
Over The Counter (OTC) Medicines and Supplies
To order OTC products online,
click here.
Quality Program
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.
Quality Monitoring
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 also monitors its internal processes.
Ultimate Health Plans annually measures the quality of care and services its members receive through the use of HEDIS® measures
(Healthcare Effectiveness Data and Information Set). 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 maintains programs to improve patient
safety, such as through medication reconciliation and the use of high-risk medications.
Quality Monitoring
Ultimate Health Plans uses the Quality Program to implement ongoing, continuous quality improvement projects and interventions.
Examples of quality projects may include:
- Flu shot clinics
- Reminder calls to members when they are due for specific care, such as a mammogram or colonoscopy
- Member incentive programs
- Provider education
Measuring and Reporting Quality
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 at
Ultimate Health Plans is evaluated by the National Committee for Quality Assurance (NCQA) every three years. You can review
our report card here: https://reportcards.ncqa.org/#/health-plan/Hp_3_1_001G000001uwtBdIAI
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).