2017 Benefit Highlights
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1 Riverside County 2017 Benefit Highlights SCAN Classic (HMO) Heart First (HMO SNP)
2 Riverside County Plan Details SCAN CLASSIC HEART FIRST Monthly Plan Premium $0 $0 Annual Plan Deductible $0 $0 Comprehensive Care SCAN CLASSIC HEART FIRST Primary Care Office Visits $0 $0 Specialist Office Visits $0 $0 Diabetic Supplies (Lancets, Test Strips, Monitor) $0 $0 Annual Physical Exam $0 $0 Preventive Services (Medicare-Covered Screenings) $0 $0 SCAN Classic A Medicare Advantage Plan which includes comprehensive preventive and hospital care plus complete prescription drug coverage. It s our most popular plan designed around the benefits and services that people use most. Lab Services and X-Rays $0 $0 Diagnostic Tests and Procedures $0 $0 Durable Medical Equipment $0-20% $0-20% Outpatient Rehabilitation $10 $10 Diagnostic Radiology (e.g., MRI, CT) $125 $125 Therapeutic Radiology $60 $60 Heart First A Chronic Special Needs Plan available to anyone with Medicare who has been diagnosed with Cardiovascular Disorder or Chronic or Congestive Heart Failure. Hospital and Emergency Care SCAN CLASSIC HEART FIRST Inpatient Hospital Care Skilled Nursing Facility $0 per day (Unlimited days) $0 per day (days 1-20) $100 per day (days ) Outpatient Surgery $50-$150 $75-$100 Emergency Care $75 (Worldwide) ($0 if admitted immediately) $75 per day (days 1-5) $0 per day (days 6 and beyond) $0 per day (days 1-20) $50 per day (days ) $75 (Worldwide) ($0 if admitted immediately) Urgent Care Services $20 (Worldwide) $20 (Worldwide) Ambulance Services $200 (per one-way trip) $225 (per one-way trip) Maximum Out-of-Pocket SCAN CLASSIC HEART FIRST Annual Maximum Out-of-Pocket (MOOP) $3,400 $3,400
3 Prescription Drug Coverage SCAN CLASSIC HEART FIRST Pharmacy Network Preferred Standard Preferred Standard Part D Deductible $0 $0 $0 $0 Initial Coverage Stage - SCAN Contracted Pharmacy (1-month/30-day Supply of Drugs) TIER 1: Preferred Generic Drugs $0 $5 $0 $5 TIER 2: Generic Drugs $7 $12 $7 $12 TIER 3: Preferred Brand Drugs $42 $47 $42 $47 TIER 4: Non-Preferred Drugs $95 $100 $95 $100 TIER 5: Specialty Tier Drugs 33% 33% 33% 33% TIER 6: Select Care Drugs $11 $11 $11 $11 Coverage Gap Tiers 1 & 2 Tiers 1 & 2 Tiers 1 & 2 Tiers 1 & 2 Savings Opportunity - Get a 3-month (90 days) supply of Tier 1 and Tier 2 drugs at either a Retail Pharmacy or SCAN Mail-Order Pharmacy and only pay for 2 months.
4 In 2016, 90% of SCAN members say they are satisfied 2016 Medicare & You, Centers for Medicare and Medicaid Services, Southern California edition, page 156m, September 2015 Additional Benefits and Services Vision Services (Routine) SCAN CLASSIC HEART FIRST Eye Exam $10 (1 per year) $0 (1 per year) Glasses or Contacts Copay $10 (every 2 years) $30 (every 2 years) Coverage for Frames or Contacts $135 (every two years) $175 (every two years) Hearing Services (Routine) Hearing Exam $0 (1 per year) $0 (1 per year) Hearing Aid Copay $699/$999 (per aid/per year) $699/$999 (per aid/per year) Transportation (Routine) $0 (12 one-way trips) $0 (20 one-way trips) Health Club Membership $0 $0 Home Delivered Meals Not Covered $0 (criteria and limitations apply) Optional Supplemental Plans SCAN CLASSIC HEART FIRST Basic Dental Plan $8 per month $8 per month Enhanced Dental Plan $16 per month $16 per month Additional Benefits and Services are benefits not offered by traditional Medicare. These are above and beyond benefits available outside of your medical network, so no referrals are needed. For more information, look through the Summary of Benefits or call SCAN Health Plan at
5 CALL To contact an authorized SCAN representative today For more information, call the number below a.m. to 8 p.m., Monday through Friday, Pacific Time 8 a.m. to 8 p.m., 7 days a week, Pacific Time (From October 1 through February 14) TTY users: 711 Or visit our website SCAN Health Plan is and HMO plan with a Medicare contract. Enrollment in SCAN Health Plan depends on contract renewal. You must continue to pay your Medicare Part B premium. Heart First is a Coordinated Care Plan. Heart First is available to anyone with Medicare who has been diagnosed with Congestive Heart Failure, Cardiac Arrhythmia, Coronary Artery Disease, Peripheral Vascular Disease, or Chronic Venous Thromboembolic Disorder. This information is not a complete description of benefits. Contact the plan for more information. Benefits, premium, co-payments and/or co-insurance may change on January 1 of each year. Limitations, copayments and restrictions may apply. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Calling the agent number will direct you to a licensed insurance agent. You can get prescription drugs shipped to your home through our network automated mail-order delivery program. Typically, you should expect to receive your prescription drugs within 14 days from the time that the mail-order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact SCAN Health Plan s Member Services. SCAN Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SCAN Health Plan cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. SCAN Health Plan 遵守適用的聯邦民權法律規定, 不因種族 膚色 民族血統 年齡 殘障或性別而歧視任何人 ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to February 14. From February 15 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day. (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al El horario es de 8 a. m. a 8 p. m., los siete días de la semana, del 1 de octubre al 14 de febrero. Del 15 de febrero al 30 de septiembre, nuestro horario es de 8 a. m. a 8 p. m., de lunes a viernes. Los mensajes recibidos en días festivos o fuera de nuestras horas de oficina serán contestados dentro de un día hábil. (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 月 1 日至 2 月 14 日期間的服務時間為早上 8 點至晚上 8 點, 每週七天 2 月 15 日至 9 月 30 日期間的服務時間為週一至週五, 早上 8 點至晚上 8 點 在節假日及營業時間之外收到的訊息將在一個工作日內回覆 ( 聽障專線 :711) Y0057_SCAN_9705_2016F File & Use Accepted G /16 17C-BHL500
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