Disclosures

Use this outline to compare benefits and premiums among policies.
READ YOUR POLICY VERY CAREFULLY. This is only an outline describing your policy's most important features. The Certificate of Coverage (COC) is your insurance contract. You must read the COC itself to understand all of the rights and duties of both you and FirstCommunity Health Plan, Inc.

Right To Return Policy

If you find that you are not satisfied with your policy, you may return it to:
FirstCommunity Senior Select
P.O. Box 2887
Huntsville, AL 35804-2887

If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.

Policy Replacement

If you are replacing another health insurance policy, do not cancel it until you have actually received your new policy and are sure you want to keep it.

Notice

This policy may not fully cover all of your medical costs.Neither FirstCommunity Health Plan, Inc. nor its agents are connected with Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details.

Complete Answers Are Very Important

When you fill out the application for the new policy, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information.

Review the application carefully before you sign it. Be certain that all information has been properly recorded.

Emergency Coverage

For emergency conditions, care is available 24 hours per day and 7 days per week at any emergency facility. You simply use the nearest emergency care facility, then call your physician and FirstCommunity Senior Select within 24 hours.

Full Medicare Supplemental benefits will be paid at any non-participating hospital any time you are treated for symptoms which require emergency care, or when medical services are immediately required for an unforeseen illness, injury or other condition and it is not reasonable to obtain such services through a participating hospital.

Referrals For Services Not Available In Participating Hospitals

If the services you require are not available at a participating hospital, then your physician may refer you to a non-participating hospital and your Medicare-approved services will be covered by your Medicare Select policy.

Quality Assurance

When you purchase one of our FirstCommunity Senior Select plans, you agree to use our participating hospitals. Therefore, it is our goal to make sure our participating hospitals meet rigorous quality standards and to make sure you have adequate access to them.

Complaint and Grievance Procedure

FirstCommunity Senior Select seeks to provide quality administration and services to you and our participating hospitals. It is recognized, however, that from time to time you may not be fully satisfied.

A FirstCommunity Senior Select problem resolution procedure is established for solving, as quickly and satisfactorily as possible, problems which may arise. We desire to provide a fair, accessible, and responsive method of evaluating and resolving complaints and grievances.

All complaints can be directed to Member Services by calling 256-532-2783 or 1-800-734-7826. If not resolved to your satisfaction, grievances should be expressed in writing to:


FirstCommunity Senior Select
P.O. Box 2887
Huntsville, AL 35804-2887

FirstCommunity Senior Select is a product of FirstCommunity Health Plan, Inc.