Universal HMO of Texas, Inc. Plans Terminating Universal HMO of Texas, Inc. was ordered into receivership by the State of Texas on April 18, 2013 for purposes of rehabilitation. Universal Health Care HMO of Texas also signed a mutual termination agreement with the Centers for Medicare and Medicaid Services (CMS) which would end their contract together effective 5/1/2013. As a result, at 12:01am on Wednesday 5/1/2013, all Universal Health Care HMO of Texas plans will be terminated. After 5/1/2013, CMS will not be in contract with Universal Health Group nor any of its subsidiaries
What this means for members/beneficiaries?:
CMS will disenroll the beneficiaries from Universal Health Care and they will be enrolled in Original Medicare effective May 1, 2013. Additionally, all Universal Health Care enrollees will be enrolled into a Prescription Drug Plan (PDP) effective 5/1/2013. Texas members will be enrolled in Cigna PDP for prescription drug coverage. At no point will any Universal Health Care member experience a gap in drug coverage. Members can call 1-800-MEDICARE if they need assistance identifying the prescription drug plan they have been moved into. 1-800-MEDICARE (1-800-633-4227), (TTY) 1-877-486-2048. www.medicare.gov
If the beneficiary has questions about their Prescription Drug Coverage through Cigna (Texas Members), they should call 1-800-222-6700, TTY callers 1-800-322-1451
For questions regarding Universal Health Care of Texas, Inc. please refer to the contact information below with any questions or concerns. State Health Insurance Assistance Program Questions:
Beneficiaries impacted by the contract termination will receive a notice in the mail explaining the changes in coverage and providing information about their new prescription drug coverage. They will also receive a letter from their new Prescription Drug Plan. Beneficiaries will be able to continue to see their current primary and specialty care providers under Original Medicare. Those currently in the hospital or receiving skilled nursing care or other medical treatments will continue with such care without interruption.
Other options open to beneficiaries:
Affected beneficiaries can choose to enroll in another Medicare Advantage or Prescription Drug Plan, if they do not want to remain in Original Medicare or the newly assigned Prescription Drug Plan. They have been granted a special election period during which they may make one change in their Medicare health care and prescription drug coverage. This special election period is in effect now through June 30, 2013. Coverage in the new plan is effective the first of the month following their plan selection. If a beneficiary calls 1-800-MEDICARE by April 30 and enrolls in a plan, the beneficiary coverage in the plan will be effective on May 1.
What does this mean for the providers?
It means that Universal is responsible for the members of its plans and is paying claims, reviewing/approving authorizations as appropriate, and handling the needs of the membership for services incurred up to 12:01AM May 1, 2013.
All contracts remain in effect until such time as providers are notified by Universal of a termination date and/or the provider follows the termination protocol outlined in their contract with Universal Health Care.
Universal will continue to pay claims and provide benefits and services for members related to services rendered up to the termination date of May 1, 2013.
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24-Hour Nurse Hotline
The 24-Hour Nurse Hotline is a free service for Universal Members. You can call anytime to speak with one of our nurses if:
- You are sick or hurt
- You need healthcare advice
- You are not sure where to go for help
A nurse will ask questions about your problem and to help you decide if you should:
- Go to the hospital
- Go to the doctor
- Care for yourself at home
24 Hours a Day, 7 Days a Week.
If you think you have an emergency, call 911 or local emergency services first.
Universal HMO of Texas, Inc., and Universal Health Care of Nevada, Inc.
Universal is health plan with a Medicare Contract
Universal is a health plan with a Medicare contract and a contract with the Texas Medicaid program © 2012 All Rights Reserved.
Y0068_02960P1CY13 Approved 11/02/12
Last Modified: 04/04/2013 5:30:00 PM EST