1

2011 Plan GuideMedicare Prescription Drug Plans

PDP

Y0067_PRE_EduBk_0810 CMS Approved 08/31/2010 CCRx-EDU BOOK 2011

2

Ready to start saving? Call toll-free, 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

If you take LIPITOR or CRESTOR, you may see real savings with Community CCRxSM PDP. Choose a Community CCRx Medicare Prescription Drug Plan and get LIPITOR or CRESTOR for no or low copays.

LIPITOR® and CRESTOR® for $0 to $2 per month.*

* This low copay is for each 30-day supply during the Initial Coverage Stage.

UAF101151_AD_Tier_1_pharmacy_8.25x10.75_v13.indd 1 8/19/10 1:57:26 PM

3

Hello and welcome to

Community CCRxSM PDPChoosing the right Medicare coverage has never been more important. It’s a big decision. Before you trust your health to just any plan, talk to us.

We’re Community CCRx, a federally qualified Medicare contracting Prescription Drug Plan and part of the Universal American family of healthcare products. Let us tell you about all the advantages Community CCRx members enjoy, including:

Value:• LIPITOR® and CRESTOR® for $0 to $2 per month.*Convenience:• a nationwide network of over 64,000 community pharmaciesAffordability:• low copays for high quality brand and generic drugsSupport:• pharmacy guidance to help you manage your medicines Communication:• a personal account of your prescriptions for your records Honesty:• no hidden costs or surprise feesAvailability:• offered in 50 states, the District of Columbia and the U.S. Virgin Islands

This year, why settle for “coverage” when you can have collaborative care, nationwide pharmacy support and good medicine from Community CCRx. Take the first step toward a healthier future. Call Community CCRx toll free at 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

From all of us at Community CCRx, thank you for your interest in our plans.

* This low copay is for each 30-day supply during the Initial Coverage Stage.

Contact us by mail at P.O. Box 5203, Rennselaer, NY 12144-5203 or visit online at www.Universal-American-Medicare.com.

To contact Medicare, call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048, 24 hours a day/7 days a week. Or visit Medicare online at www.Medicare.gov for more information about Medicare benefits and services including general information regarding the health or Part D benefit.

4

Medicare’s four “Parts”Medicare Part A and Part B are often called “Original Medicare.” It’s important to remember that Part C and Part D are also part of Medicare. No matter which Medicare “Part” you choose for coverage, you still have Medicare, and retain all of your Medicare rights and protections.

Remember, all Medicare health plans offered by the Universal American family of companies — including Community CCRx Prescription Drug Plans — are approved by Medicare.

Part A Hospital coverageInpatient hospital care • Inpatient stays at most skilled facilities• Hospice• Home health•

Part B Medical coverageDoctor and clinical lab services• Outpatient and preventative care• Screenings, surgical fees and supplies• Physical and Occupational therapy•

Part C Called Medicare Advantage (MA)Combines hospital and medical coverage. Medicare Advantage plans are offered as four different plan designs:

Preferred Provider Organization (Often called PPO)• Health Maintenance Organization (Often called HMO)• Private Fee-for-Service (Often called PFFS)• Special Needs Plans (Often called SNP)•

Part D Medicare Prescription Drug Coverage is available two different waysAs a Stand-alone Prescription Drug Plan (Often called PDP) • Community CCRx PDPAs prescription drug coverage added to a Medicare Advantage plan (Often called MA-PD)•

You are here

5

Community CCRx Prescription Drug Plans

Cost and coverage comparisonEach stage of Part D drug coverage affects your out-of-pocket costs depending on the plan you choose.

Community CCRx BASIC (PDP)Lower monthly premium with a Deductible

Community CCRx CHOICE (PDP)Higher monthly premium with no Deductible

Find your monthly premium on page 6

1 Annual Deductible StageCoverage begins after paying your $310 deductible

Coverage begins the very first day, with your first prescription

2 Initial Coverage Stage Amount you pay until you reach $2,840 in total yearly prescription costs

What you pay out of pocket for prescriptions

Tier 1 — Generic / Preferred Brand Drugs

$2 for 30-day supply, $6 for 90-day supply

$0 for 30-day supply, $0 for 90-day supply

Tier 2 — Preferred Brand / Non-Preferred Generic Drugs

28% - 32% coinsurance (depending on your service area)

$35 for 30-day supply, $105 for 90-day supply

Tier 3 — Non-Preferred Generic / Non-Preferred Brand Drugs

55% - 71% coinsurance (depending on your service area)

$65 for 30-day supply, $195 for 90-day supply

Tier 4 — Specialty Drugs 25% 33%

3 Coverage Gap Stage Amount you pay until you reach $4,550 in out-of-pocket drug costs

93% of Generic Drug cost, 100% of manufacturerdiscounted brand drug cost

93% of Generic Drug cost, 100% of manufacturerdiscounted brand drug cost

4 Catastrophic Coverage Stage Amount you pay after you reach $4,550 in out-of-pocket drug costs

Greater of 5% coinsurance or $2.50 copay for Generic Drugs*Greater of 5% coinsurance or $6.30 copay for All Other Drugs

Greater of 5% coinsurance or $2.50 copay for Generic Drugs*Greater of 5% coinsurance or $6.30 copay for All Other Drugs

*Includes Brand Drugs treated as Generic

Important Medicare reminder about plan benefitsThe benefit information provided herein is a brief summary, not a comprehensive • description of benefits. For more information, please contact Community CCRx.You must continue to pay your Medicare Part B premium.• Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may • change on January 1, 2012.Limitations, copayments and restrictions may apply.•

6

Use this table to find the Community CCRx plan premium for your stateYour State Basic Choice Alabama $29.50 $90.00 Alaska $47.00 $86.60 Arizona $27.90 $80.30Arkansas $28.10 $89.10 California $47.60 $89.70 Colorado $30.90 $87.80Connecticut $31.70 $83.80 Delaware $30.50 $87.10 District of Columbia $30.50 $87.10 Florida $25.50 $79.10Georgia $28.00 $87.30 Hawaii $31.80 $84.40 Idaho $39.40 $96.60 Illinois $27.60 $81.40 Indiana $31.20 $84.00 Iowa $35.60 $91.30 Kansas $35.40 $94.30 Kentucky $31.20 $84.00 Louisiana $29.80 $85.40 Maine $29.60 $84.30 Maryland $30.50 $87.10 Massachusetts $31.70 $83.80 Michigan $32.30 $81.60 Minnesota $35.60 $91.30 Mississippi $30.80 $89.50 Missouri $32.70 $85.70

Your State Basic Choice Montana $35.60 $91.30 Nebraska $35.60 $91.30 Nevada $32.50 $91.00 New Hampshire $29.60 $84.30 New Jersey $42.10 $77.30 New Mexico $20.10 $77.00 New York $30.20 $74.00 North Carolina $32.80 $84.40 North Dakota $35.60 $91.30 Ohio $27.10 $79.00 Oklahoma $32.20 $90.60 Oregon $33.00 $79.00 Pennsylvania $26.00 $80.20 Rhode Island $31.70 $83.80 South Carolina $32.70 $85.40 South Dakota $35.60 $91.30 Tennessee $29.50 $90.00 Texas $25.10 $82.40 U.S. Virgin Islands $20.30 $91.50 Utah $39.40 $96.60 Vermont $31.70 $83.80 Virginia $29.20 $82.00 Washington $33.00 $79.00 West Virginia $26.00 $80.20 Wisconsin $35.20 $84.20 Wyoming $35.60 $91.30

Important reminder about Medicare’s Extra Help ProgramPeople with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify will not be subject to the Coverage Gap or late enrollment penalty. Many people are eligible for these savings and don’t even know it. To see if you qualify for Extra Help, call:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, • 24 hours a day/7 days a week.The Social Security Office at 1-800-722-1213 between 7 a.m. and 7p.m., • Monday through Friday. TTY users should call1-800-325-0778.You may also contact your State Medicaid Office.•

7

Community CCRx is part of Universal American’s family of healthcare products

What that means to youThe Universal American family of products offers a variety of healthcare plans for people who rely on Medicare. That’s good to know, because it means as a member of our family, you can change coverage as your needs change—without ever leaving our close community of care.1

It’s also good to know that nearly 2 million2 people trust us with their prescription drug coverage, making us the second largest Medicare drug plan sponsor in the United States. 3

As our member, you’ll like that we keep our promises, and that we stay connected with you about plan benefits and health matters throughout the year.

You’ll also appreciate that your enrollment in a Community CCRx prescription drug plan marks the beginning of a supportive relationship we call our Healthy CollaborationSM.

It’s a promise from all of us at Universal American to use our resources, our people and our nationwide pharmacy network to work together with your pharmacist to help keep you healthy.1 Coverage and plan changes can only be made

during Medicare enrollment periods.2 2009 Universal American Annual Report;

available at www.UniversalAmerican.com. 3 Source: CMS.gov; April, 2010, available at

www.CMS.gov.

Take the first step toward a healthier future Enroll in a Community CCRx plan todayA helpful representative can help you complete an enrollment form right over the phone. If you prefer, you can also request the service of a qualified agent to help you complete the enrollment process.

Call toll free, 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week. Count on us for real help whenever you need it.

8

Medicare prescription drug plans

Enrollment GuidelinesYour eligibilityYou are eligible to enroll in a Medicare prescription drug plan—such as the plans in this booklet—if you are entitled to receive Medicare Part A (hospital coverage), or already enrolled in Part B (medical coverage). The plan you wish to enroll in must be available in your service area.

Note: If you are entitled to enroll in a Medicare prescription drug plan due to a disability, you may enroll three months before and up to three months after your 25th month of receiving Social Security benefits.

Enrollment in a Medicare Advantage plan with prescription drug coverage You must have both Medicare Part A and Part B coverage. For more information about eligibility in a Medicare Advantage plan with prescription drug coverage, visit www.medicare.gov.

If you choose not to enrollIf you do not enroll in a Medicare prescription drug plan when you first become eligible, and don’t have creditable drug coverage (as good as Medicare), you may be subject to a penalty if you join at a later time.

Would you like us to help explain enrollment and eligibility? We’re glad to help. We can explain your eligibility for a Medicare prescription drug plan and Medicare Advantage. Just call us toll free, 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

Medicare’s three Part D prescription drug coverage enrollment periodsInitial Enrollment Period (IEP) You may enroll in a Medicare prescription drug plan three months before the month you turn 65, during the month you turn 65 and three months afterward.

Annual Election Period (AEP) If you choose not to enroll during Medicare’s Initial Enrollment Period, your next opportunity comes during Medicare’s Annual Election Period, which begins November 15, and ends December 31, 2010.

Special Election Period (SEP) Medicare also allows you to enroll under certain special circumstances other than the IEP and the AEP. To find out more about these special enrollment times, visit Medicare’s website at www.medicare.gov.

9

Medicare Advantage

Simplify your lifeThinking of choosing separate medical, hospital and prescription drug coverage? Maybe it’s time to consider a Medicare Advantage plan1.

Often called an “MA” plan, a Medicare Advantage plan can simplify your Medicare because it combines hospital and medical coverage into one plan.

For still more simplicity, you can add prescription drug coverage to an MA plan (called MA-PD plan). MA-PD plans are all-in-one plans that often include additional value-added services not always offered with separate coverage.

Think about it: one premium, one plan and one ID card. It means less time spent managing your healthcare and more time spent enjoying your life.

No one plan is right for everyone. But everyone deserves a choice. To learn more about the choices we offer, call us toll free at 1-888-304-6271, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.

1 Our Medicare Advantage plans are not available in all service areas. To find out if our Medicare Advantage plans are available in your service area, contact the plan.

Important Medicare Part D Enrollment Reminders

Members may enroll in the plan only • during specific times of the year. Contact Community CCRx for more information.You may only be enrolled in one Part D • plan at a time. If you are enrolled in a Medicare Advantage coordinated care (HMO or PPO) plan or a Medicare Advantage Private Fee-for-Service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a prescription drug plan unless you disenroll from the Medicare Advantage HMO, PPO, or PFFS plan. Members of a PFFS plan that does not provide Medicare prescription drug coverage or an MA Medical Savings Account (MSA) plan may enroll in a prescription drug plan. Enrollees in an 1876 Cost Plan may also enroll in a prescription drug plan.

10

Your 2010-2011 Medicare CalendarDate and Year Why this time is important for you to remember

Your 65th Birthday

You are now eligible for MedicareFor eligible Americans, this marks the beginning of your Medicare years. Make this the day you take the first step toward a healthier future by enrolling in a Community CCRx Medicare prescription drug plan.

Remember, you can enroll three months before your 65th birthday, during your birthday month, and up to three months after your birthday.

October 1,

2010Medicare Plan Information becomes available to youThis is the first day that Medicare allows plans to tell you about their coverage choices and plan benefits. This is your opportunity to consider costs and coverage choices before the Medicare Annual Election Period (AEP) begins.

Begins November 15,

EndsDecember 31,

2010

Medicare’s Annual Election Period (AEP)During this time, you may enroll in a Community CCRx Medicare prescription drug plan or switch to a Community CCRx plan from your current drug plan.You may also change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Any enrollment change you make during the AEP will take effect January 1. Remember, for most Medicare beneficiaries, this is the only period during which you can change prescription drug plans.

When special circumstances apply

Medicare’s Special Election Period (SEP)Medicare will allow you the opportunity to join a prescription drug plan or switch to a different plan should you experience an unusual circumstance such as moving to a new service area. To find out more about these special enrollment opportunities visit Medicare online at www.medicare.gov.

Want to know more about dates, enrollment periods or your eligibility?Call us at 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week. Or visit us online, at www.Universal-American-Medicare.com.

11

Your pharmacist could very well be the clinical expert you see more often than any other—including your doctor. He or she is always there to provide neighborhood care and good medicine just for stopping by the pharmacy.

Community CCRx recognizes just how important pharmacists are. We support the care they provide working together with doctors and hospitals to help manage medicines properly and safely.

We also support pharmacists through our exclusive affiliation with the National Community Pharmacists Association (NCPA). NCPA is dedicated to promoting all the positive things independent pharmacists do for our members1.

As you consider prescription drug plans, remember that Community CCRx members are always welcome in over 64,000 network pharmacies nationwide.

That means whether at home or traveling the country, the Community CCRx pharmacist is always there to support you, your health and your prescription drug plan—without ever needing an appointment.

If you’re looking for a drug plan that offers affordable drug coverage, provides quality brand and generic medicines and supports a healthy relationship with your local pharmacist, you’ve found it.

Community CCRx.1 The foundation of our Community CCRx

Medicare Prescription Drug Plans is our exclusive affiliation with the National Community Pharmacists Association (NCPA).

Your Community CCRx pharmacist

Expert care, no appointment necessary

About our pharmacy network: Community CCRx has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in emergencies or urgent situations, and quantity limitations and restrictions may apply. The pharmacies in our network can change at any time. You can ask for a Pharmacy Directory or visit us at www.Universal-American-Medicare.com. Our Customer Service number is 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

Take the first step toward a healthier future right now, and enroll in a Community CCRx plan todayFour easy ways to enroll in a Community CCRx plan

Call us for enrollment assistance:We can help you complete an enrollment form right over the phone. Call toll free, 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

Request a licensed agent:You can also request the service of a qualified, licensed agent to help you complete the enrollment process. Call toll free, 1-866-423-5040, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-866-684-5351) 7 days a week.

Enroll online: If you have access to the Internet, you can complete the online enrollment form on our Web site and submit it to us online (or by mail) when you visit us at: www.Universal-American-Medicare.com.

Mail your Enrollment Form:Complete the Prescription Drug Plan Enrollment Form found in a Community CCRx Enrollment Kit and drop it in the mail. The Community CCRx Enrollment Form can be found on our Web site at www.Universal-American-Medicare.com. Our Enrollment Kits are available through your local pharmacy or from a qualified, licensed agent.

Community CCRxSM PDP is a federally qualified Medicare contracting Prescription Drug Plan and is offered by the following organizations that contract with the Federal government: American Progressive Life & Health Insurance Company of New York and Pennsylvania Life Insurance Company, members of the Universal American family of companies.

If you have special needsYou can request this document in other formats and languages by calling 1-866-423-5040 (TTY users call 1-866-684-5351) 7 days a week.

Si usted tiene necesidades especialesPuede solicitar este documento en otros formatos e idiomas llamando al 1-866-423-5040 (Usuarios de TTY llamar al 1-866-684-5351) los siete días de la semana.