Benefits

Coverage & Benefits


To learn about the benefits and coverage provided by IMCare Classic (HMO SNP), read your IMCare Classic MSHO Member Handbook (PDF) (Evidence of Coverage).  It outlines how to receive care while being a part of the IMCare Classic.  It reviews covered services, non-covered services, co-pays, and more. It gives details about the health care services and prescription drugs we will cover.  It tells how to get your health care and prescription drugs as an IMCare Classic (HMO SNP) member. It also explains the rights, benefits, and responsibilities of members. Benefits, formulary, pharmacy network, premium, and/or copays may change on January 1 of each year.
  • Chapter 1: Getting started as a member
  • Chapter 2: Important phone numbers and resources
  • Chapter 3: Using the plan’s coverage for your health care and other covered services
  • Chapter 4: Benefits Chart*
  • Chapter 5: Getting your outpatient prescription drugs through the plan
  • Chapter 6: What you pay for your Medicare and Medical Assistance (Medicaid) prescription drugs
  • Chapter 7: Asking us to pay our share of a bill you have gotten for covered services or drugs
  • Chapter 8: Your rights and responsibilities
  • Chapter 9: What to do if you have a problem or complaint (coverage decisions, Appeals, complaints)
  • Chapter 10: Ending your membership in our Plan
  • Chapter 11: Legal notices
  • Chapter 12: Definitions of important words
Note: *Chapter 4 tells what is covered and what is not covered.

Organization Determinations


IMCare has made an organization determination when it makes a decision about whether items or services are covered or how much you have to pay for covered items or services. Organization determinations are also called “coverage decisions” in the MSHO Member Handbook (PDF) (Evidence of Coverage).

Getting Care During a Declared Disaster


If you live in county included in a state of disaster or emergency declaration, you can get health care services from network or out-of-network providers at no cost to you during the disaster or emergency. You do not need a Service Authorization for covered services. You may get your prescription drugs at any pharmacy. If you are getting services through your county, contact the county for continuing coverage of those services. Services can continue this way, through the declared disaster's start date through its end date. 

*IMCareClassic 114 (Website) 
PENDING CMS review & approval MM/DD/YYYY