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Member Information |
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We appreciate your interest in the HM Care Advantage Limited Benefit Medical Plan. As an HM Care Advantage member, you are eligible to receive certain benefits as determined by your specific plan. The types of services and the amount of coverage that is available to you is summarized in the enrollment brochure or, as a member, is shown in the Outline of Coverage you received in the mail with your identification card that also shows your plan benefits.
The information on this page provides you more details regarding your coverage (or the coverage that is being offered to you) to help you better manage your health and associated costs. The links below provide a quick reference to information available on this page.
For additional information regarding other benefits included with your HM Care Advantage coverage,
contact one of the service areas below.
Member Client Services:
866.225.9030
8:00 a.m. – 7:00 p.m. ET
Monday through Friday
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Prospective Member Call Center:
800.481.9979
8:30 a.m. – 7:00 p.m. ET
Monday through Friday
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Surgery Benefit
This benefit pays the scheduled amount shown in the Schedule of Surgical Benefits for surgical procedures performed at a licensed hospital, outpatient facility or physician's office. The maximum benefit amount that will be paid per surgery is shown on the Benefit Summary in the enrollment brochure for prospective members and in the Outline of Coverage a member receives upon enrollment. The number of surgery benefits that will be paid is limited by the number of surgical procedures defined in the plan. However, there are 74 surgical procedures that are eligible for a scheduled payment, but do not apply to the maximum number of surgical procedures. An explanation of how this benefit is paid and a list of the 74 procedures are available on the informational sheet linked below. For additional information regarding the surgery benefit, members can call Client Services at
866.225.9030; prospective members can contact the Call Center at 800.481.9979.
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Provider Network Discounts*
When the Provider Network Discounts benefit is included in your plan, you have
the option to use providers in the MultiPlan provider network. If you utilize
one of the participating providers (hospitals, physicians or ancillary care
providers), discounts will apply that could lower your out-of-pocket expenses.
MultiPlan provides access to health care providers throughout the nation,
including 4,500 acute care facilities, 98,000 ancillary locations and more than
560,000 physicians. Discounts from using network providers continue to apply to
your medical bills even after your other benefits are exhausted.
Information on participating providers can be obtained by calling 800.672.2140 or from the online MultiPlan provider directory.
If your benefit materials specify a different provider network and you would like additional information, call Client Services at 866.225.9030.
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Complementary Wellness Discount Program
Members may obtain savings on health-related products and services through a network of over 35,000 practitioners and facilities. Discounts of up to 30% may be applied to products and services such as fitness centers, spas, personal trainers, yoga, acupuncture, massage therapy, vitamins/supplements, nutrition counseling, health-related magazines and more. In order to obtain a discount, you must show your HM Care Advantage membership card. Please note that you are responsible for paying the discounted price for services directly at the time service is rendered.
This program is provided by Healthways WholeHealth Networks, Inc. Find participating
wellness service providers online or call
877.244.2465, Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern time. Members should confirm their discount by showing their HM Care Advantage ID card at the time of service.
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Health Information On-Call
Personalized education and support are just a phone call away. Members may obtain information on a wide range of health topics, 24 hours a day, seven days a week, at no cost. This toll-free service provides unlimited access to “Health Coaches” such as specially trained nurses, respiratory therapists or dietitians who are available to answer questions concerning your or your family’s health.
Call 800.830.3998 (TTY 800.464.0613) and provide the identification number that appears on your HM Care Advantage membership card to speak to a “Health Coach.” This service is provided by Health Dialog Services Corporation.
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Health Information On-Line
Through this online resource, members may obtain lifestyle improvement programs, health information and resources on a range of topics including smoking cessation, nutrition, weight management, stress management, chronic conditions, back pain, insomnia, depression, diabetes and other general health topics. The user-friendly Web site provides practical assistance and may be referenced at no charge. . .anytime, day or night.
To obtain health information, members can login using the instructions on the
Health Information On-Line site. Prospective members can get more information about the program by reading the About section and by clicking Learn More on the home page of the informational site. This service is provided by HealthMedia® Inc.
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Pharmacy Discount Card*
The Pharmacy Discount Card is provided to members whose plan does not include the insured prescription drug benefit. With the card, you may obtain average discounts of up to 20% on prescription medicines at participating retail pharmacies. The discounts are available for brand and generic prescriptions with no limit on the number of prescriptions filled. You must show your HM Care Advantage membership card to receive a discount.
This is not insurance. The program administrator may obtain manufacturer rebates and other fees based on your prescription drugs. These rebates and other fees may be retained by the program administrator or shared with you and/or your pharmacy. This program is available through Caremark. To obtain a list of participating pharmacies or for more information, call
877.321.2652 or use the links below.
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Outpatient Prescription Drug Insurance*
When outpatient prescription drug insurance is included in a plan, medically necessary prescriptions can be filled with co-pays at participating and non-participating pharmacies to a benefit maximum as determined by your benefit level (Tier I, Tier II or Tier III). Discounts up to 40%, based on average wholesale price for generic drugs, apply before and after the benefit maximum is reached. The Outpatient Prescription Drug Insurance benefit is offered through
Catalyst RX and is underwritten by Fidelity Security Life Insurance Company. For a list of participating pharmacies or more information regarding prescription drugs covered under this plan, call
800.997.3784 or visit www.catalystrx.com and use the appropriate Plan User Name and Password as shown below to login.
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Tier I |
Tier II |
Tier III |
$15 Co-pay
Generic Formulary |
$10 Co-pay
Generic Formulary |
$10 Co-pay
Generic Formulary |
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$15 Co-pay Generic Oral |
$15 Co-pay Generic Oral |
$15 Co-pay Generic Oral |
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Formulary Contraceptives |
Formulary Contraceptives |
Formulary Contraceptives |
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Brand Name Not Covered |
Brand Name Not Covered |
$50 Co-pay
Brand Name Formulary
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$750 Max. Benefit |
$1,000 Max. Benefit |
$1,000 Max. Benefit |
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Generic Formulary |
Generic Formulary |
Generic and Brand Name Formulary |
Plan User Name: HCMA15
Password: HCMA15
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Plan User Name: HCMA10
Password: HCMA10
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Plan User Name: HCMAGP
Password: HCMAGP
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Vision Discount*
The Vision Discount program is available to members whose plan does not include Vision Insurance. With the Vision Discount benefit, you may receive a routine eye examination once a year as well as obtain discounts on other services such as frames, spectacles, contact lenses and laser vision correction. Services must be provided by a network provider.
This vision plan is administered by Davis Vision, Inc. To obtain the name of a Davis Vision contracted provider near you, call
800.999.5431 to use the Interactive Voice Response Unit or find a provider using the online Davis Vision provider directory. To use the online directory, you will need to enter your Social Security Number in the ID field and the first five letters of your last name in the Password field. Prospective members can obtain access by using Control Code: 4264
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Vision Insurance*
When vision insurance is included in a plan, covered persons are eligible to receive one eye examination, and one pair of spectacle lenses or one pair of contact lenses, and one set of frames during the benefit cycle as defined by their plan. If you use in-network providers, you will receive the maximum benefit for eligible vision care. Reimbursement is provided if you use non-network providers. An outline of benefits is included with the information members receive with their membership card.
This vision plan is administered by Davis Vision, Inc. To obtain the name of a Davis Vision contracted provider near you, call
800.999.5431 to use the Interactive Voice Response Unit or find a provider using the online Davis Vision provider directory. To use the online directory, members will need to enter their Social Security Number in the ID field and the first five letters of their last name in the Password field. Prospective members can obtain access by using Control Code: 4264
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Dental Insurance*
When dental coverage is included in a plan, members can obtain benefits for
preventive, restorative and major dental services. The benefit amount that a
member receives is summarized on the prospective member’s enrollment brochure
and specified in the information a member receives following enrollment.
Coverage is underwritten by Fidelity Security Life Insurance Company or
Renaissance Life & Health Insurance Company of America. For more information
regarding these coverages, refer to your plan documentation or use the
appropriate contact information below.
Fidelity Security Life Insurance Company: Members: contact Client
Services at 866.225.9030. Prospective members: contact the Call Center at
800.481.9979
Renaissance Life & Health Insurance Company of America: Contact customer
service at 888.358.9484, Monday - Friday from 8:00 a.m. to 5:00 p.m. ET. Your
Renaissance dental benefit may include a provider network (see your plan
documentation or ID card). Members whose dental plan includes the provider
network have the option of using any of the more than 60,000 Dental Wellness
Partners (DWP) dentist locations to reduce the cost of service. The DWP online
directory can help you find a participating dentist location nearest to you.
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* Not included with all plans – see your plan documentation as noted above to confirm whether these benefits are available to you or whether you have enrolled in a plan that includes these benefits.
Please be aware that some of these products and services are provided by organizations other than HM Insurance Group. By selecting links on this page, you may enter a discount or other service provider’s site, which is governed by the service provider’s respective privacy policy.
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