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Minnesota Senior Care Plus (MSC+)
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Minnesota Senior Health Options (MSHO)
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Special Needs BasicCare (SNBC) With Medicare
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MEDICA®
OV/CONV/URGI/ER/[6D5] $XX I $XX I $XX I $XX I [$XX] In case of EMERGENCY go to the nearest Emergency Room or call 911.
No Medicare coverage. Full drug coverage through Medica.
medica.com/accessability
Member Services (TTY 711( Nurseline TM by HealthAdvocate TM Medica Behavioral Health Delta Dental Questions: Pharmacies call CVS: P roviders call:
1-888=3� 7-3630 1-866-715-0915 1-800-848-8327 1-800-459-8574 1-866-693-46201-800-458-5512
Card Issued: 12/20/18
Medical claims to: Medica, PO Box 30990 , Salt Lake City, T 84130-0990
Dental Claims: Delta Dental®, PO Box 1328 , Minneapolis, MN 55440-1328
RX Claims: CVS Caremark, PO Box 52136 , Phoenix, AZ. 85072-2136
Appeals and Grievances: State of MN - DHS Appeals Unit, PO Box 64941 , St Paul, MN 55164-0941 Managed Care Ombudsman- 1-651-431-2660 or 1-800-657-3729 (TTY: 711)
Special Needs BasicCare (SNBC) No Medicare