2026 Disclaimers
Simpra Advantage Information:
Simpra Advantage is a PPO I-SNP and PPO D-SNP with a Medicare contract. Enrollment in Simpra Advantage plans depends on CMS Medicare contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system. Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Based on a Model of Care review, Simpra Advantage has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (SNP) through 2027. Accommodations are available for persons with special needs. Call Member Services at 1-844-637-4770 (for accommodations call TTY/TDD 1-833-312-0044).
Special Supplemental Benefits for the Chronically Ill (SSBCI) Information:
2026 Simpra Advantage Nursing Home Plan (PPO I-SNP): Social Companion Support is a Special Supplemental Benefit for the Chronically Ill (SSBCI). To be eligible for Social Companion Support, you must have one or more of the following chronic conditions: Dementia or Chronic and disabling mental health conditions. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
2026 Simpra Advantage Dual Care (PPO D-SNP): Food and Produce, General Supports for Living, and Social Needs benefits are Special Supplemental Benefits for the Chronically Ill (SSBCI). To be eligible for these benefits, you must have one or more of the following chronic conditions: Cardiovascular disorders, Chronic heart failure, Stroke, Dementia, Diabetes, or other eligible conditions not listed here. These conditions may not apply to all types of SSBCI benefits. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
2026 Simpra Advantage Assist (PPO I-SNP): Social Companion Support and Food and Produce are Special Supplemental Benefits for the Chronically Ill (SSBCI). To be eligible for SSBCI benefits, you must have one or more of the following chronic conditions: Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic lung disorders or other conditions not listed here. These conditions may not apply to all types of SSBCI benefits. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
Over-the-Counter Benefit Information:
The Benefits Mastercard® Prepaid Card is issued by The Bancorp Bank N.A., pursuant to license by Mastercard International Incorporated and card can be used for eligible expenses wherever Mastercard is accepted. Mastercard and the circles design is a trademark of Mastercard International Incorporated. Valid only in the U.S. No cash access. This is not a gift card or gift certificate. Prepaid cards are distributed as a gratuity without the payment of any monetary value or consideration. This card cannot be used to pay for prescription drugs or products that are not eligible. Product exclusions include alcohol, tobacco, firearms and gift cards. If you would like to buy items that are not eligible, you will need to use another form of payment. Only Nations Benefits® supports the 2026 Over-the-Counter (OTC) benefit.
Out-of-Network Provider Information:
Go to https://simpra.com/for-members/out-of-network-coverage-rules/ for information on Out-of-Network coverage. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Click here for more information on call Member Services (for accommodations call TTY/TDD 1-833-312-0044) or see your Evidence of Coverage (https://simpra.com/for-members/plan-documents/) for more information, including the cost-sharing that applies to out-of-network services.