Benefits Handbook

The Surest Copay plan uses the UnitedHealthcare Choice Plus Broad network which is available nationwide.

Using the network is not mandatory, except in instances of infertility care, but generally, you will pay less out-of-pocket when using an in-network provider.

Copays will be higher when you use out-of-network providers.

In the event that you receive care from an out-of-network doctor (such as an anesthesiologist) while being treated at an in-network facility, benefits will be paid at the in-network level.

The network includes general practitioners, as well as specialists and hospitals. These network providers are selected by and contracted with the Claims Administrator.

There is a specialty network of providers specific to infertility treatments and services, through WINFertility ("WIN"). Please see the "Is there a network of providers for infertility-related treatments? for information on finding and utilizing in-network providers for infertility treatment and services.

Depending on the geographic area and the service you receive, you may have access through Surest's Shared Savings Program to non-Network providers who have agreed to discounts negotiated from their charges on certain claims for Covered Services, when applicable. Shared Savings is a program in which Surest Copay Plan may obtain a discount to a non-Network provider's billed charges. This discount is usually based on a schedule previously agreed to by the non-Network provider, and there's no balance billing in these instances. There are some instances where a non-Network provider may bill you for the difference between the billed amount and the rate determined by Surest Copay Plan. If this happens you should call the number on your ID Card.

Surest is your Claims Administrator if you live within the United States.

You must access a Surest Copay Plan Network Provider in order to receive the Network level of benefits.

The doctors and hospitals in the network are listed in a provider directory. The Claims Administrator provides an online directory of providers or you may call the Claims Administrator.

Network provider lists can change, so take the time to review the networks to determine which networks your health care providers participate in before choosing a third party administrator and network.

Important: In-network participating providers can change at any time; therefore, the network information you gather may not be accurate for all or part of the plan year. You will NOT be permitted to change your medical plan election during the plan year, even if any or all of your providers stop participating in any network at any point during the plan year.

Call Member Services at +1 866 683 6440 or visit Benefits.Surest.com. On the Surest website:

There is a network of mental health providers. Providers in the network are listed in a provider directory. The Claims Administrator provides an online directory available at Benefits.Surest.com or the Surest mobile app. You may also call Surest Member Services at +1 866 683 6440.

Network provider lists can change, so take the time to review the networks to determine which networks your health care providers participate in before choosing a third party administrator and network.

Important: In-network participating providers can change at any time; therefore, the network information you gather may not be accurate for all or part of the plan year. You will NOT be permitted to change your medical plan election during the plan year, even if any or all of your providers stop participating in any network at any point during the plan year.

There is a network of providers under WINFertility ("WIN's") network focused on infertility related treatments. WIN is a specialty infertility network.

Providers in the WIN network can be found at https://managed.winfertility.com/mmc-2 or by downloading the WINFamily app.

Note: Only providers who are participating in WIN's network are covered. There is no coverage if you use an out-of-network provider for infertility-related treatments

There is a pharmacy network associated with this Plan. You may use a pharmacy in the network as well as out-of-network to receive coverage under this Plan.

Note that when you go to a pharmacy that's out-of-network, you need to submit a claim form for reimbursement. Refer to "How do I file a prescription drug claim form with CVS Caremark®?" for more information.

The Prescription Drug Benefits Manager, CVS Caremark®, provides an online directory of network pharmacies available at www.caremark.com.

To locate an in-network retail pharmacy:

Or call CVS Caremark® at +1 844 449 0362 for more information.

Yes. WIN's pharmacy network will provide all prescription drugs related to infertility treatments.

There is NO out-of-network infertility-related prescription drug coverage under the WINFertility program.

To locate an in-network pharmacy for your infertility prescriptions:

All of the pharmacies listed can mail the infertility prescriptions to your home, but there are retail pick-up options available in many areas as well.

Once your prescription order has been received by WIN, in the Review Rx screen, the "Select Best Pharmacy for Selected Drugs" tool will help identify the pharmacy closest to you (when retail pick-up is available) and match you with the best priced in-network pharmacy that has the infertility medications in your order in stock.

Your WIN Nurse Care Advocate will discuss the prescription process with you, as well as any preferred formulary drugs and treatment authorizations needed prior to processing any associated prescriptions. Your WIN Nurse Care Advocate also has access to the "Select Best Pharmacy for Selected Drugs" tool to help you find the closest pharmacy to you (when retail pick-up is available) with the best prices for your prescription.

Download the WINFamily App on the App store or Google Play using app code: MMC18 to view and manage your prescriptions directly in the app, including a cost-estimator tool to help you locate where the medications can be dispensed at the lowest price.