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
Acclaim by Ultimate (011), Pinellas
Elite by Ultimate (013-3), Pasco
Premier by Ultimate (001), Hernando
- Evidence of Coverage
Acclaim Plus by Ultimate (012), Pinellas
Premier Plus by Ultimate (014-1), Hernando and Pasco
- Evidence of Coverage
Elite by Ultimate (013-4), Citrus
- Evidence of Coverage
Premier Plus by Ultimate (014-2), Citrus
- Evidence of Coverage
Ascend Plus by Ultimate (016 and 018), Marion and Sumter
- Evidence of Coverage
Advantage Care by Ultimate (019), Hernando and Pasco
- Evidence of Coverage
Advantage Care by Ultimate (021), Citrus
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.
Quality Management Program