UCare's Coverage Policies Disclaimer

Coverage Policies are developed to assist in identifying coverage for UCare benefits under UCare’s health plans. They are intended to serve only as a general reference regarding UCare’s administration of health benefits, and are not intended to address all issues related to coverage for health services provided to UCare members.

These services may or may not be covered by all UCare products (refer to product section of individual coverage policy for product-specific detail). Providers are encouraged to have their UCare patient refer to their UCare plan documents (Evidence of Coverage/Member Handbook/Member Contract) for specific coverage information. If there is a conflict between a coverage policy and the UCare plan document, the UCare plan document is used to determine coverage.

Coverage Policies do not constitute medical advice. Providers are responsible for submission of accurate and compliant claims.

How Coverage Policies Are Developed

UCare Coverage Policies are developed based on the applicable UCare plan documents, and available regulatory guidance. UCare Coverage Policies further define benefits in the applicable plan documents. Note that coverage policies do not exist for every benefit section of the relevant plan document.

UCare Coverage Policies are reviewed annually, and updated as needed.

Coverage policies are subject to change.

How Coverage Policies Are Used

When making coverage decisions, UCare staff apply the benefits associated with the member’s enrollment and eligibility, according to federal and state regulations, and the member’s specific plan document (Evidence of Coverage/Member Handbook/Member Contract). UCare Staff reference Coverage Policies, when available, in addition to the UCare member’s specific plan document. UCare’s Coverage Policies help to clarify a section of the UCare member’s plan document.