Clear Spring Health Select (HMO) -
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Overview
Additional Information
Keep your costs low with a Health Maintenance Organization (HMO) plan that has a SO or low monthly premium.
Monthly Premium
Provider
Find a Participating Provider
Covered Prescription Drug
Find a Covered Drug
Pharmacy
Find a Participating Pharmacy
Medical Coverage
Medical Deductible
Maximum Out-of-Pocket
PCP Visit
Specialist Visit
Inpatient Hospitalization
Outpatient Surgery at a Hospital
Ambulatory Surgery Center (ASC)
Emergency Room
Ambulance Services
Urgently Needed Care
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Skilled Nursing Facility (SNF)
Home Health Care
Durable Medical Equipment (DME)
Outpatient Mental Health
Chiropractic Services
Podiatry Services
Dental
Vision
Hearing
Over the Counter (OTC) Items
Transportation
Telehealth Services
Fitness
Prescription Drug Deductible
Initial Coverage Limit
Covered Prescription Drug Benefits
Covered Prescription Drug Benefits (cont.)
Disenrollment Form
Enrollment Form
Evidence of Coverage
Formulary
LIS Premium Chart
Multi language Interpreter Services
Notice of Non-Discrimination
Over-the-Counter Catalog
Pharmacy Directory
Pre-Enrollment Checklist
Provider Directory
Star Rating
Summary of Benefits
Clear Spring Health
Select
(HMO) –
Monthly Premium
Contract Number:
Enroll Now
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Enrollee must continue to pay their Medicare Part B premium. This information is not a complete description of benefits. Call 1-877-364-4566 (TTY: 711) for more information.
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Clear Spring Healthâs pharmacy network includes limited lower-cost, preferred pharmacies. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call or consult the online Pharmacy Locator.
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Other pharmacies and other providers are available in our network.
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Out-of-network/non-contracted providers are under no obligation to treat Clear Spring Health plan members, except in emergency situations. Please call Member Service or review the Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Provider
Additional Information
Keep your c
Additional Information
Keep your c
Additional Information
Keep your c
Enrollment is Easy!

Call 1 (877) 364-4566 TTY:711 and a trained sales representative will answer any questions and enroll you right over the phone.
Preferred Pharmacy Cost-Sharing
Pharmacy Option
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Tier 1: Preferred Generic |
Tier 2: Generic |
Tier 3: Preferred Brand |
Tier 4: Non-Preferred Drug |
Tier 5: Specialty |