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Provider Manual

Benefit Explanation

Last Updated on September 15, 2021

The following pages describe the Medicare Advantage benefit package generally. Security Health Plan offers a variety of Medicare Advantage Plan options.

  • Ally RX DSNP – is a dual-eligible special needs plan with an HMO network. This means members must receive care from an affiliated provider. Any care received out of network requires prior authorization. Most services are subject to Medicare cost-sharing as members have a Medicaid secondary plan to supplement their out of pocket costs.
  • Medicare Advantage HMO-POS Plans – have no in or out of network deductible but members are responsible for copayments and coinsurance on some benefits. These plans have both in and out of network coverage.
  • Secure Saver MSA – is a high-deductible health plan with a Medicare medical savings account. This plan does not include Part D prescription drug coverage or the above and beyond benefits that Security Health Plan’s other Medicare Advantage plans offer. Services received under this plan are subject to a deductible (including preventive services) until the member’s out of pocket is met. After the deductible, covered services are paid at 100% of the Medicare allowed amount.

Coverage will be provided in accordance with Medicare guidelines (written in the Medicare Advantage Evidence of Coverage [EOC]) and is subject to member eligibility at the time services are provided. Services that are not covered by Medicare are not covered by Medicare Advantage plans, except as specifically set forth in the EOC.

Benefits are subject to change. Verification of benefits should be directed to Security Health Plan Provider Customer Service at 1-800-548-1224. Copies of the current Rx and non-Rx EOCs which contain the details of Medicare Advantage coverage are available at https://www.securityhealth.org/find-a-plan/medicare-overview/medicare-documents?page=1&tag=2021AllyRxDSNP.