Evidence of Coverage

2018 Evidence of Coverage

Signature With Drugs

Learn the details about your Medicare, healthcare and prescription drug coverage for the year.

Signature With Drugs
Evidence of Coverage

Download the Spanish Language Version


Signature Without Drugs

Learn the details about your Medicare, healthcare and prescription drug coverage for the year.

Signature Without Drugs
Evidence of Coverage

Download the Spanish Language Version


Champion Plan

Learn the details about your Medicare, healthcare and prescription drug coverage for the year.

Champion Plan
Evidence of Coverage

Download the Spanish Language Version


Freedom Plan

Learn the details about your Medicare, healthcare and prescription drug coverage for the year.

Freedom Plan
Evidence of Coverage

Download the Spanish Language Version


Guardian Plan

Learn the details about your Medicare, healthcare and prescription drug coverage for the year.

Guardian Plan
Evidence of Coverage

Download the Spanish Language Version


This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.

You must continue to pay your Medicare Part B premium.

For more information on Erickson Advantage, just stop by the office Monday through Friday 8:30 a.m.-5:00 p.m. or call 1-866-774-9671, TTY: 711. 8 a.m. - 8 p.m. local time, 7 days a week.

This information is available for free in other languages. Please call our customer service number at 1-866-314-8188, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-866-314-8188, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Please read the UnitedHealthcare Non-Discrimination Notice.

Language Assistance/Non-Discrimination Notice