This information is not a complete description of benefits. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Medicare has neither reviewed nor endorsed this information. The list of covered drugs (formulary), provider and pharmacy network may change at any time. You will receive notice when necessary. Other Pharmacies/Physicians/Providers are available in our network. Contact OneCare Customer Service if you need help finding a provider.
OneCare complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available for free in other languages. Call OneCare Customer Service toll-free at 1-877-412-2734 (TTY 711), 24 hours a day, 7 days a week. Visit us at www.caloptima.org/OneCare.