2025 MCS Classicare Efectivo (HMO)

MCS Classicare is a product subscribed by MCS Advantage, Inc. MCS Classicare is an HMO plan with a Medicare contract and a contract with Puerto Rico Medicaid program. Enrollment in MCS Classicare depends on contract renewal. Based on a Model of Care review, MCS Classicare has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (SNP) through 2025. 1. SSBCI: The benefits mentioned are a part of special supplemental program for members with chronic diseases, such as: Cardiovascular disorders, Hypertension, Diabetes, Chronic and disabling mental health conditions, Chronic kidney disease and other conditions not listed. Eligibility cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided. For details, please contact us.VBID: Eligibility for the Additional Benefits under the VBID Model is not assured and will be determined by MCS after enrollment, based on relevant criteria (area deprivation index). Amounts may vary per coverage. If you have questions, need materials on a standing basis in alternate formats and/or languages or need oral interpretation services, you can call us at 1.866.627.8183 (TTY: 1.866.627.8182). 2. MCS Classicare Intelicare (HMO) is a coordinated care coverage. 3. Unused amounts does not roll over to the next month for the following groups: MCS Classicare Efectivo (HMO), MCS Classicare InteliCare (HMO), MCS Classicare Exacto (HMO) and MCS Classicare En Tu Hogar (HMO).4. Unused amounts do not rollover to the next month or quarter. 5. Some services may require pre-authorization. Contact the plan for details. 6. Benefits may vary per coverage. Call us or refer to your Evidence of Coverage available on our website www.mcsclassicare.com for benefit information, limitations and exclusions. 7. Access to the network of providers throughout Puerto Rico. The service area for MCS Classicare Excede Region 1 is 13 municipalities, Excede Region 2 is 21 municipalities, Del Caribe is 8 municipalities, Firme is 39 municipalities, Metro is 8 municipalities. For details see the Evidence of Coverage or contact the plan.