HealthPartners Freedom Plan

Size: px
Start display at page:

Download "HealthPartners Freedom Plan"

Transcription

1 HealthPartners Freedom Plan Group Summary of Benefits Emeriti 2007 H2462

2 2

3 Table of Contents Group Plan Information Introduction Summary of Benefits Inpatient Care Outpatient Care Outpatient Medical Services and Supplies Preventive Services Additional Benefits (What Original Medicare does NOT cover) HealthPartners is a health plan with a Medicare contract. 3

4 Choice - Control - Affordability The HealthPartners Freedom Group plan is being offered to you through your employer. Your employer understands the importance of having more than just Original Medicare. This document is designed to provide you with basic details regarding your coverage. If you should have any questions that are not answered within this document, please contact HealthPartners. Join the Freedom Frequent Fitness Program at no additional cost to you As a HealthPartners Freedom Group plan Medicare member, when you enroll and work out at least eight times a month at one of the participating fitness clubs, you can enjoy the Freedom Frequent Fitness Program at no additional cost. HealthPartners pays the full cost of your monthly membership! 4

5 HealthPartners Freedom Group Plan Information Great health care coverage The family of HealthPartners Freedom Group plan offers all the benefits that are available under Original Medicare and more. No referral required This plan features an open access network. That means you can see any network provider without a referral. The extensive network includes most Minnesota doctors and hospitals. It s likely you'll be able to keep your current doctor. If you do not call to activate the Extended Absence coverage before your trip, you will still be able to use your Original Medicare benefits when obtaining care outside the plan s network, but will be responsible for Medicare deductibles, coinsurance and any additional charges not covered by Medicare. Emergency and urgently needed services are an exception to this requirement and are covered anywhere in the world. When you travel, take your health plan with you at no extra cost With the Extended Absence benefit, you can get your plan's level of coverage while you are away from Minnesota for up to nine months. You will need to call HealthPartners each time before you receive services outside of Minnesota to activate the coverage. Once activated, coverage begins immediately. The Extended Absence benefit coverage is the same as in-network coverage. The Extended Absence benefit can only be used outside the state of Minnesota and within the United States. The out-of-state providers you see must participate in the Medicare program. They will bill Medicare first for Medicareeligible services. These providers may require you to pay for non-medicare covered services at the time they are provided. You may then submit a claim to HealthPartners for payment of services covered by HealthPartners. 5

6 Coverage for emergency and urgentlyneeded care anywhere in the world A medical emergency is when you reasonably believe that your health is in serious danger when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse. Urgently needed services are also covered wherever you need them. These are the health care services which you need and which cannot be delayed, as a result of unforeseen illness, injury or condition under circumstances that make it unreasonable to obtain services in the network. If you need urgent care while you are in the service area, go to your clinic or any of the network s urgent care centers. Emergency services are covered worldwide, whenever you need them. In an emergency call 911, or go to the nearest hospital or emergency medical center. Attention Persons with Diabetes: If you have diabetes and enroll in a Medicare Part D Prescription Drug plan, your syringes, oral or injectable insulin, alcohol, swabs and gauze will be covered under your Medicare Part D plan and NOT your Medicare Part B coverage. All other diabetes supplies will remain covered by your Durable Medical Equipment benefit under Medicare Part B coverage. See Page 22 for details. 6

7 Enrollment is easy 1 2 Compare the HealthPartners Freedom Group plan options in the enclosed Summary of Benefits with the limitations of Original Medicare. Mail your completed enrollment form(s) to HealthPartners in the enclosed postage-paid envelope. Or call us at the number listed below. Completed enrollment forms that are received by HealthPartners by the last working day of the month are generally effective the first day of the next calendar month. For example: a completed enrollment form received by HealthPartners on January 30, 2007, is effective February 1, HealthPartners contract with CMS is renewed annually and the availability of coverage beyond the end of the current contract year is not guaranteed. Eligibility for plan membership is based on eligibility for Medicare Parts A and B or Part B only. It is not based on age, health status, prior or anticipated use of health services, or preexisting conditions. There is no health screening. Just complete the application forms in this packet and mail them in the enclosed envelope with a copy of your Medicare card. In general, you cannot be a member of two Medicare HMO plans or Medicare Prescription Drug Plans at the same time. You automatically cancel membership in other Medicare HMO (Medicare Advantage or Cost) plans and Medicare Prescription Drug Plans when you join this plan. Automatic cancellation does not apply to Medicare Select/Supplemental plans. You must live in Minnesota. You must not have End Stage Renal Disease (ESRD) and cannot be in a Medicare hospice program. (The ESRD eligibility condition does not apply if you are already a HealthPartners member and are within one month of enrolling in Medicare Parts A and B or Part B only.) If you have Medicare Part B only and are enrolling in this plan, please note that you will only have coverage for Medicare Part B services. You will not have coverage for hospital, skilled nursing facilities, and related services covered by Medicare Part A. You may contact the Social Security Office at if you wish to purchase Medicare Part A coverage. For questions regarding medical and dental plan options, call or , Monday - Friday, 8 a.m. to 6 p.m. TTY users should call or For questions about Medicare Part D prescription drug benefits, including copayments, deductibles and network pharmacies, call or , 7 days a week, 8 a.m. to 8 p.m. TTY users should call or Or visit us at healthpartners.com/medicare. 7

8 Introduction to the Summary of Benefits for HealthPartners Freedom Group Plan January 1, December 31, 2007 Thank you for your interest in HealthPartners Freedom Group plan. Our plan is offered by HEALTHPARTNERS, a Medicare Cost Managed Care plan. This Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover, every limitation, or every exclusion. To get a complete list of our benefits, please call HealthPartners and ask for the "Evidence of Coverage." YOU HAVE CHOICES IN YOUR HEALTH CARE As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (fee-for-service) Medicare Plan. Another option is a Medicare group health plan, like HealthPartners Freedom Group plan. You may have other options too. You make the choice. No matter what you decide, you are still in the Medicare Program. You may join or leave a plan only at certain times. Please call HealthPartners at the number listed at the end of this introduction or MEDICARE ( ) for more information. TTY users should call You can call this number 24 hours a day, 7 days a week. HOW CAN I COMPARE MY OPTIONS? You can compare HealthPartners Freedom Group plan and the Original Medicare Plan using this Summary of Benefits. The charts in this booklet list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year. WHERE IS HEALTHPARTNERS FREEDOM PLAN AVAILABLE? The service area for this plan includes the following counties: Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, and Yellow Medicine counties. You must live in one of these places to join the plan. WHO IS ELIGIBLE TO JOIN HEALTHPARTNERS FREEDOM PLAN? You can join HealthPartners Freedom plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease (ESRD) are not eligible to enroll in HealthPartners Freedom plan. 8

9 CAN I CHOOSE MY DOCTORS? HealthPartners has formed a network of doctors, specialists, and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or visit us at healthpartners.com/medicare. Our number is listed at the end of this introduction. WHAT HAPPENS IF I GO TO A DOCTOR WHO'S NOT IN YOUR NETWORK? You can always choose to go to a doctor outside our network. We may not pay for the services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for Medicare Part B deductible and coinsurance. DOES MY PLAN COVER MEDICARE PART B AND MEDICARE PART D DRUGS? HealthPartners Freedom Group plan covers both Medicare Part B and Medicare Prescription Drug Program Part D drugs. WHAT TYPES OF DRUGS MAY BE COVERED UNDER MEDICARE PART B? The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but is not limited to, the following types of drugs. Contact HealthPartners for more details. -- Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision. -- Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare. -- Erythropoietin (Epoetin alpha or Epogen ): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia. -- Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia. -- Injectable Drugs: Most injectable drugs administered incident to a physician s service. -- Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility. -- Some Oral Cancer Drugs: If the same drug is available in injectable form. -- Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen. Inhalation and infusion drugs provided through DME. Please call HealthPartners for more information about this plan.visit us at healthpartners.com/medicare or call us: Member Services hours: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, 8:00 a.m. - 8:00 p.m. Central. Current members should call ( TTY/TDD ). Prospective members should call (TTY/TDD ) For more information about Medicare, call Medicare at MEDICARE ( ). TTY users should call You can call 24 hours a day, 7 days a week. Or, visit on the web. If you have special needs, this document may be available in other formats. 9

10 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I Important Information 1 Premium and Other Important Information 2 Doctor and Hospital Choice (For more information, see Emergency #15 and Urgently Needed Care #16) Most people will pay the standard monthly Part B premium of $ However, starting January 1, 2007, some people will have to pay a higher premium because of their yearly income (over $80,000 for singles, $160,000 for married couples). For more information on Part B premiums based on income, call Social Security at TTY users should call You may go to any doctor, specialist or hospital that accepts Medicare You will continue to pay the Medicare Part B premium of $93.50 each month. (This is the 2007 amount and may change January 1, 2008.) There is a $1,500 maximum out-of-pocket limit every year for all plan services. You pay an additional premium of $ per month. You do NOT need a referral to go to network doctors, specialists and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. You are covered for U.S. visitor/travel benefits. Summary of Benefits Inpatient Care 3 Inpatient Hospital Care (Includes Substance Abuse and Rehabilitation Services) You pay for each benefit period: (3) Days 1-60: an initial deductible of $992 Days 61-90: $248 each day Days : $496 each lifetime reserve day (4) (These are 2007 amounts and may change January 1, 2008.) Please call MEDICARE ( ) for information about lifetime reserve days (4) You pay $100 per benefit period. Except in an emergency, your provider must obtain authorization from HealthPartners. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you may pay more. 10

11 Plan II You will continue to pay the Medicare Part B premium of $93.50 each month. (This is the 2007 amount and may change January 1, 2008.) There is a $3,000 maximum out-of-pocket limit every year for all plan services. You pay an additional premium of $ per month. You do NOT need a referral to go to network doctors, specialists and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. You are covered for U.S. visitor/travel benefits. You pay $100 per benefit period. Except in an emergency, your provider must obtain authorization from HealthPartners. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 11

12 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 4 Inpatient Mental Health Care You pay the same deductible and copayments as inpatient hospital care (see Page 10) except Medicare beneficiaries may only receive 190 days in a Psychiatric Hospital in a lifetime. You pay $100 per benefit period. Medicare beneficiaries may only receive 190 days in a Psychiatric Hospital in a lifetime. Except in an emergency, your provider must obtain authorization from HealthPartners. 5 Skilled Nursing Facility (In a Medicare-certified skilled nursing facility) You pay for each benefit period (3), following at least a 3-day covered hospital stay: Days 1-20: $0 for each day. Days : $124 for each day There is no copayment for services in a Skilled Nursing Facility. Three day prior hospital stay is required. You are covered for 100 days each benefit period. (These are the 2007 amounts and may change January 1, 2008.) There is a limit of 100 days for each benefit period. (3) 6 Home Health Care (Includes medically necessary intermittent skilled nursing care, home health aide services, and rehabilitation services, etc.) There is no copayment for all covered home health visits. There is no copayment for Medicare-covered home health visits. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 12

13 Plan II You pay $100 per benefit period. Medicare beneficiaries may only receive 190 days in a Psychiatric Hospital in a lifetime. Except in an emergency, your provider must obtain authorization from HealthPartners. There is no copayment for services in a Skilled Nursing Facility. Three day prior hospital stay is required. You are covered for 100 days each benefit period. There is no copayment for Medicare-covered home health visits. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 13

14 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I Outpatient Care 7 Hospice You pay part of the cost for outpatient drugs and inpatient respite care. You must receive care from a Medicarecertified hospice. You must receive care from a Medicarecertified hospice. 8 Doctor Office Visits You pay 20% of Medicare-approved amounts. (1) (2) You pay $15 for each primary care or specialty care office visit for Medicarecovered services. See 32-Physical Exams for more information. 9 Chiropractic Services You are covered for manual manipulation of the spine to correct subluxation, provided by chiropractors and other qualified providers. You pay 100% for routine care. You pay 20% of Medicare-approved amounts. (1) (2) You pay $15 for each Medicare-covered visit (manual manipulation of the spine to correct subluxation). (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 14

15 Plan II You must receive care from a Medicare-certified hospice. You pay $20 for each primary care or specialty care office visit for Medicare-covered services. See 32-Physical Exams for more information. You pay $20 for each Medicare-covered visit (manual manipulation of the spine to correct subluxation). (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 15

16 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 10 Podiatry Services You pay 20% of Medicare-approved amounts. (1) (2) You are covered for medically necessary foot care, including care for medical conditions affecting the lower limbs. You pay 100% for routine care. You pay $15 for each Medicare-covered visit (medically-necessary foot care). You pay $15 for each routine visit. Authorization rules may apply for services. 11 Outpatient Mental Health Care You pay 50% of Medicare-approved amounts with the exception of certain situations and services for which you pay 20% of approved charges. (1) (2) For Medicare-covered Mental Health services, you pay $15 for each individual therapy session and $7.50 for each group therapy session. Authorization rules may apply for services. 12 Outpatient Substance Abuse Care You pay 20% of Medicare-approved amounts. (1) (2) For Medicare-covered services, you have 100% coverage of the cost of each individual/group session. There is a 75-hour limit for treatment per calendar year. Except in an emergency, your provider must obtain authorization from HealthPartners. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 16

17 Plan II You pay $20 for each Medicare-covered visit (medically necessary foot care). You pay $20 for each routine visit. For Medicare-covered Mental Health services, you pay $20 for each individual therapy session and $10 for each group therapy session. For Medicare-covered services, you have 100% coverage of the cost of each individual/group session. There is a 75 hour limit for treatment per calendar year. Except in an emergency, your provider must obtain authorization from HealthPartners. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 17

18 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 13 Outpatient Services/Surgery You pay 20% of Medicare-approved amounts for the doctor. (1) (2) 100% coverage for each Medicare-covered visit to an ambulatory surgical center. You pay 20% of outpatient facility charges. (1) (2) 100% coverage for each Medicare-covered visit to an outpatient hospital facility. Authorization rules may apply for services. 14 Ambulance Services (Medically necessary ambulance services) You pay 20% of Medicare-approved amounts or applicable fee schedule charges. (1) (2) 100% coverage for Medicare-covered ambulance services. You pay 20% of the charges incurred outside the United States. Authorization rules may apply for services. 15 Emergency Care (You may go to any emergency room if you reasonably believe you need emergency care.) You pay 20% of the facility charge or applicable copayment for each emergency room visit; you do NOT pay this amount if you are admitted to the hospital for the same condition within 3 days of the emergency room visit. (1) (2) You pay 20% of doctor charges. (1) (2) NOT covered outside the U.S. except under limited circumstances. You pay $50 for each Medicare-covered emergency room visit; however, the copay is waived if you are admitted to the hospital within 24 hours with the same condition. You pay 20% of the cost for each emergency room visit outside the United States. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 18

19 Plan II 100% coverage for each Medicare-covered visit to an ambulatory surgical center. 100% coverage for each Medicare-covered visit to an outpatient hospital facility. 100% coverage for Medicare-covered ambulance services. You pay 20% of the charges incurred outside the United States. You pay $50 for each Medicare-covered emergency room visit; however, the copay is waived if you are admitted to the hospital within 24 hours with the same condition. You pay 20% of the cost for each emergency room visit outside the United States. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 19

20 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit 16 Urgently Needed Care (This is NOT emergency care, and in most cases, is out of the service area) Original Medicare You pay 20% of Medicare-approved amounts or applicable copayment. (1) (2) NOT covered outside the U.S. except under limited circumstances. You pay $15 for each Medicare-covered urgently needed care visit. You pay 20% of the cost for each urgently needed care visit outside of the United States. Worldwide coverage. Plan I Outpatient Medical Services and Supplies 17 Outpatient You pay 20% of Medicare-approved Rehabilitation amounts. (1) (2) Services (Occupational Therapy caps include: therapy, Physical - Physical and speech therapy at $1,740 per therapy, Speech calendar year. and Language - Occupational therapy at $1,740 per therapy) calendar year. 100% coverage for each Medicare-covered Occupational Therapy and/or Physical Therapy session. You pay $15 for each Medicare-covered Speech/Language therapy session. 18 Durable Medical Equipment (Includes wheelchairs, oxygen, etc.) You pay 20% of Medicare-approved amounts. (1) (2) You pay 10% of the cost for each Medicare-covered item. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 20

21 You pay $20 for each Medicare-covered urgently needed care visit. You pay 20% of the cost for each urgently needed care visit outside of the United States. Worldwide coverage. Plan II You have 100% coverage for each Medicarecovered Occupational Therapy and/or Physical Therapy session. You pay $20 for each Medicare-covered Speech/Language therapy session. Contact plan for details You pay 10% of the cost for each Medicarecovered item. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 21

22 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 19 Prosthetic Devices (Includes braces, artificial limbs and eyes, etc.) You pay 20% of Medicare-approved amounts. (1) (2) You pay 10% of the cost for each Medicarecovered item. 20 Diabetes Self- You pay 20% of Medicare-approved Monitoring amounts. (1) (2) Training and Supplies (Includes coverage for glucose monitors, test strips, lancets, screening tests and selfmanagement training) 21 Diagnostic Tests, X-Rays and Lab Services You pay 20% of Medicare-approved amounts, except for approved lab services. (1) (2) There is no copayment for Medicareapproved lab services. You pay $15 of the cost for diabetes selfmonitoring training. You pay 10% of the cost for each Medicarecovered diabetes supply item. Please refer to page 6 for more information on diabetes supplies. You have: - 100% coverage for each Medicare-covered clinical/diagnostic lab service % coverage for each Medicare-covered radiation therapy service % coverage for each Medicare-covered X-ray visit. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 22

23 Plan II You pay 10% of the cost for each Medicarecovered item. You pay $20 of the cost for Medicare-covered Diabetes self-monitoring training. You pay 10% of the cost for each Medicarecovered Diabetes supply item. Please refer to page 6 for more information on Diabetes supplies. You pay: - 100% coverage for each Medicare-covered clinical/diagnostic lab service % coverage for each Medicare-covered radiation therapy service % coverage for each Medicare-covered X-ray visit. See page 34 for additional information about lab services. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 23

24 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I Preventive Services 22 Bone Mass You pay 20% of Medicare-approved Measurement (For amounts. (1) (2) people with Medicare who are at risk) 23 Colorectal You pay 20% of Medicare-approved Screening Exams amounts. (1) (2) (For people with Medicare age 50 and older) 24 Immunizations (Flu There is no copayment for the pneumonia vaccine, Hepatitis B and flu vaccines. vaccine - for people with You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine. (1) Medicare who are at (2) risk, pneumonia You may only need the pneumonia vaccine) vaccine once in your lifetime. Please contact your doctor for further details. 25 Mammograms (Annual Screening) (For women with Medicare age 40 and older) 26 Pap Smears and Pelvic Exams (For women with Medicare) You pay 20% of Medicare-approved amounts. (2) No referral necessary for Medicarecovered screenings. There is no copayment for a Pap smear once every 2 years, annually for beneficiaries at high risk. (2) You pay 20% of Medicare-approved amounts for pelvic exams. (2) 100% coverage for each Medicarecovered Bone Mass measurement. Authorization rules may apply for services. 100% coverage for each Medicarecovered Colorectal screening exam. Authorization rules may apply for services. There is no copayment for the pneumonia and flu vaccines. No referral necessary for Medicare-covered influenza and pneumonia vaccines. There is no copayment for the Hepatitis B vaccine. Authorization rules may apply for services. There is no copayment for Medicarecovered screening Mammograms. Authorization rules may apply for services. No referral necessary for Medicarecovered screenings. There is no copayment for Medicarecovered Pap smears and pelvic exams. Authorization rules may apply for services. 27 Prostate Cancer Screening Exams (For men with Medicare age 50 and older) There is no copayment for approved lab services and a copayment of 20% of Medicare-approved amounts for other related services. (1)(2) There is no copayment for Medicarecovered Prostate Cancer screening exams. Authorization rules may apply for services. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 24

25 Plan II 100% coverage for each Medicare-covered Bone Mass measurement. 100% coverage for each Medicare-covered Colorectal screening exam. There is no copayment for the pneumonia and flu vaccines. No referral necessary for Medicare-covered influenza and pneumonia vaccines. There is no copayment for the Hepatitis B vaccine. There is no copayment for Medicare-covered screening Mammograms. No referral necessary for Medicare-covered screenings. There is no copayment for Medicare-covered Pap smears and pelvic exams. There is no copayment for Medicare-covered Prostate Cancer screening exams. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 25

26 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 28 Prescription Drugs Drugs covered under Medicare Part B (Original Medicare) Drugs covered under Medicare Part D (Prescription Drug Benefit) Deductible Initial Coverage In-Network Retail Pharmacy You pay 100% for most prescription drugs, unless you enroll in the Medicare Prescription Drug program. You pay 20% of the cost for Part B-covered drugs. This plan uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our website at healthpartners.com/medicare. People who have limited incomes, who live in long term care facilities, or who have access to Indian/Tribal/Urban (Indian Health Service) facilities may have different out-of-pocket drug costs. There is no deductible. You pay the following for prescription drugs: - $12 for a one month (30-day) supply of formulary generic drugs. - $24 for a one month (30-day) supply for formulary brand name drugs. - 25% coinsurance for a one month (30-day) supply of formulary specialty drugs. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 26

27 Plan II You pay 20% of the cost for Part B-covered drugs. This plan uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our website at healthpartners.com/medicare. People who have limited incomes, who live in long term care facilities, or who have access to Indian/Tribal/Urban (Indian Health Service) facilities may have different out-of-pocket drug costs. Contact plan for details. There is no deductible. You pay the following for prescription drugs: - $10 for a one month (30-day) supply of formulary generic drugs. - $31 for a one month (30-day) supply for formulary brand name drugs. - 25% coinsurance for a one month (30-day) supply of formulary specialty drugs. - $30 for a three month (90-day) supply of formulary generic drugs. - $93 for a three month (90-day) supply of formulary brand name drugs. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 27

28 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I Mail Order Coverage After You Reach Your Initial Coverage Limit Catastrophic Coverage General Information - $12 for a one month (30-day) supply of formulary generic drugs. - $24 for a one month (30-day) supply of formulary brand name drugs. - 25% coinsurance for a one month (30- day) supply of formulary specialty drugs. - $24 for a three month (90-day) supply of formulary generic drugs. - $48 for a three month (90-day) supply of formulary brand name drug. Coverage remains the same. After your yearly out-of-pocket drug costs reach $3,850, you pay the greater of: - $2.15 for generic (including brand name drugs treated as generic) and $5.35 for all other drugs; or - 5% coinsurance. You may incur a cost in addition to the copay if you select a higher drug when a lesser cost drug is available. In some cases, the plan requires you to first try one drug to treat your medical condition before they will cover another drug for that condition. Certain prescription drugs will have maximum quantity limits. Your provider must get prior authorization from your plan for certain prescription drugs. Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside the plan s service area where there is no network pharmacy. You may also incur an additional cost for drugs received at an out-of-network pharmacy. Please contact you plan for details. 28

29 Plan II - $10 for a one month (30-day) supply of formulary generic drugs. - $31 for a one month (30-day) supply of formulary brand name drugs. - 25% coinsurance for a one month (30-day) supply of formulary specialty drugs. - $20 for a three month (90-day) supply of formulary generic drugs. - $62 for a three month (90-day) supply of formulary brand name drug. After the total yearly drug costs (paid by both you and your plan) reach $2,400, you pay 100% of your prescription drug costs until your yearly out-of-pocket drug costs reach $3,850. After your yearly out-of-pocket drug costs reach $3,850, you pay the greater of: - $2.15 for generic (including brand name drugs treated as generic) and $5.35 for all other drugs; or - 5% coinsurance. You may incur a cost in addition to the copay if you select a higher drug when a lesser cost drug is available. In some cases, the plan requires you to first try one drug to treat your medical condition before they will cover another drug for that condition. Certain prescription drugs will have maximum quantity limits. Your provider must get prior authorization from your plan for certain prescription drugs. Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside the plan s service area where there is no network pharmacy. You may also incur an additional cost for drugs received at an out-of-network pharmacy. Please contact you plan for details. 29

30 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I Additional Benefits (what Original Medicare does not cover) 29 Dental Services In general, you pay 100% for preventive dental services. You pay 100% for preventive dental services. Authorization rules may apply for services. 30 Hearing Services You pay 100% for routine hearing exams and hearing aids. In general, you have 100% coverage for routine hearing exams. You pay 20% of Medicare-approved amounts for diagnostic hearing exams. (1) (2) You pay 50% of the charges incurred up to $1,000 maximum every two years for hearing aids. Authorization rules may apply for services. 31 Vision Services You are covered for one pair of eyeglasses or contact lenses after each cataract surgery. (1) (2) For people with Medicare who are at risk, you are covered for annual glaucoma screenings. (1) (2) You pay 20% of Medicare-covered amounts for diagnosis and treatment of diseases and conditions of the eye. (1) (2) You pay 100% for routine eye exams and glasses. You have 100% coverage for routine eye exams. There is no copayment for the following items: - Eye wear frames or lenses for the postoperative treatment of cataracts. You pay: - $15 copay for each Medicare-covered eye exam (diagnosis and treatment for diseases and conditions of the eye). (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 30

31 Plan II You pay 100% for preventive dental services. In general, you have 100% coverage for routine hearing exams. You pay 50% of the charges incurred up to $1,000 maximum every two years for hearing aids. You have 100% coverage for routine eye exams. There is no copayment for the following items: - Eye wear frames or lenses for the postoperative treatment of cataracts. You pay: - $20 copay for each Medicare-covered eye exam (diagnosis and treatment for diseases and conditions of the eye). (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 31

32 If you have any questions about this plan s benefits or costs, please contact HealthPartners. Benefit Original Medicare Plan I 32 Physical Exams If your coverage for Medicare Part B begins on or after January 1, 2005, you may receive a one-time physical exam within the first six months of your new Part B coverage. This will not include laboratory tests. Please contact your plan for further details. You pay 20% of the Medicare-approved amount. (1) (2) 33 Health/Wellness You pay 100%. Education If your coverage for Medicare Part B begins on or after January 1, 2005, you may receive a one-time physical exam within the first six months of your new Part B coverage. This will not include laboratory tests. Please contact your plan for further details. There is no copayment for routine physical exams. You are covered for the following: - Written health education materials, including a newsletter. - Smoking cessation. - Health club membership/fitness classes. - Nursing hotline. Authorization rules may apply for services. 34 Acupuncture You pay 100%. You pay $15 for each acupuncture visit. Authorization rules may apply for services. (1) Each year, you pay a total of one $131 deductible. (2) If a doctor or supplier chooses not to accept an assignment, their costs are often higher, which means you pay more. 32

33 Plan II If your coverage for Medicare Part B begins on or after January 1, 2005, you may receive a onetime physical exam within the first six months of your new Part B coverage. This will not include laboratory tests. Please contact your plan for further details. There is no copayment for routine physical exams. You are covered for the following: - Written health education materials, including a newsletter. - Smoking cessation. - Health club membership/fitness classes. - Nursing hotline. You pay $20 for each acupuncture visit. (3) A benefit period begins the day you go to the hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of the benefit periods you can have. (4) Lifetime reserve days can only be used once. 33

34 HealthPartners rd Avenue South P. O. Box 1309 Minneapolis, MN healthpartners.com 2006 HealthPartners HP (9/06) Emeriti

Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties

Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties Summary of Benefits New York: Bronx, Kings, New York, Queens and Richmond Counties January 1, 2006 - December 31, 2006 You ve earned the right to live life on your own terms. And that includes the right

More information

Freedom Blue PPO SM Summary of Benefits

Freedom Blue PPO SM Summary of Benefits Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR

More information

Summary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO

Summary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO 2009 Health Net Summary of benefits Los Angeles, Orange, Riverside and San Bernardino counties s effective January 1, 2009 H0562 Medicare Advantage HMO Material ID H0562-09-0041 CMS Approval 9/08 Section

More information

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Minnesota

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Minnesota HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Minnesota HealthPartners Freedom Plan I (Cost) HealthPartners Freedom Plan II (Cost) HealthPartners Freedom Plan III (Cost) 420090 (10/10)

More information

2011 Summary of Benefits

2011 Summary of Benefits SM Core, Choice and s (Cost) H2461 2011 Summary of Benefits January 1, 2011 December 31, 2011 H2461_072110_F02 MN CMS Approved 08/27/2010 Section I Introduction to the Summary of Benefits for Core, Choice

More information

MEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.

MEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS. ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction

More information

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin HealthPartners Freedom Plan 2011 Medical Summary of Benefits Wisconsin HealthPartners Wisconsin Freedom Plan I HealthPartners Wisconsin Freedom Plan II 420421 (10/10) H2462_SB WI_151 CMS Approved 10/5/10

More information

SUMMARY OF BENEFITS 2009

SUMMARY OF BENEFITS 2009 HEALTH NET VIOLET OPTION 1, HEALTH NET VIOLET OPTION 2, HEALTH NET SAGE, AND HEALTH NET AQUA SUMMARY OF BENEFITS 2009 Southern Oregon Douglas, Jackson, and Josephine Counties, Oregon Benefits effective

More information

SmartSaver. A Medicare Advantage Medical Savings Account Plan. Summary of Benefits and Other-Value Added Services. From Blue Cross of California

SmartSaver. A Medicare Advantage Medical Savings Account Plan. Summary of Benefits and Other-Value Added Services. From Blue Cross of California SmartSaver From Blue Cross of California A Medicare Advantage Medical Savings Account Plan Service Area C Summary of Benefits and Other-Value Added Services H5769 2007 CO 415 09/22/06 Introduction to the

More information

Summary of Benefits Advantra Freedom PEBTF

Summary of Benefits Advantra Freedom PEBTF Advantra Freedom is a Medicare Advantage Private Fee-For-Service (PFFS) Plan. This Summary of Benefits tells you some features of our Plan. It doesn't list every service that we cover or list every limitation

More information

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California

More information

Summary of Benefits for SmartValue Classic (PFFS)

Summary of Benefits for SmartValue Classic (PFFS) Summary of Benefits for SmartValue Classic (PFFS) Available in Select Counties in Nevada A health plan with a Medicare contract. Rocky Mountain Hospital and Medical Service, Inc. has contracted with the

More information

HealthPartners Freedom Plans

HealthPartners Freedom Plans HealthPartners Freedom Plans 2013 Summary of Benefits Minnesota HealthPartners Freedom Basic (Cost) HealthPartners Freedom Vital (Cost) HealthPartners Freedom Balance (Cost) HealthPartners Freedom Ultimate

More information

Y0021_H4754_MRK1427_CMS File and Use PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract

Y0021_H4754_MRK1427_CMS File and Use PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract Y0021_H4754_MRK1427_CMS File and Use 08262012 PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract Section I - Introduction to Summary of s Thank you for your interest in.

More information

2014 Summary of Benefits

2014 Summary of Benefits 2014 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) Value Plus (HMO-POS) Classic (HMO-POS) (H2459) January 1, 2014 - December 31, 2014 Minnesota H2459_082213 CMS Accepted (08272013) SECTION

More information

Recommendations from the Minnesota Department of Health (MDH) for Completing the CDC Facility TB Risk Assessment Worksheet

Recommendations from the Minnesota Department of Health (MDH) for Completing the CDC Facility TB Risk Assessment Worksheet Recommendations from the Minnesota Department of Health (MDH) for Completing the CDC Facility TB Risk Assessment Worksheet The Facility TB Risk Assessment Worksheet, developed by the Centers for Disease

More information

Summary of Benefits PFFS. FreedomBlue SM. Pennsylvania January 1, 2010 through December 31, 2010

Summary of Benefits PFFS. FreedomBlue SM. Pennsylvania January 1, 2010 through December 31, 2010 2010 FreedomBlue SM PFFS Summary of Benefits Pennsylvania January 1, 2010 through December 31, 2010 A detailed side-by-side comparison of FreedomBlue PFFS plans and Original Medicare. H9793_09_0350 CMS

More information

Summary of Benefits. for Blue Medicare Access Value SM (Regional PPO) Available in Ohio

Summary of Benefits. for Blue Medicare Access Value SM (Regional PPO) Available in Ohio Summary of Benefits for SM Available in Ohio Anthem Blue Cross and Blue Shield is a Health plan with a Medicare contract.anthem Insurance Companies, Inc. (AICI) is the legal entity that has contracted

More information

Select Summ ary. VIVA MEDICARE Plus Select (HMO) INTRODUCTION TO THE SUMMARY OF BENEFITS FOR. You have choices in your health care.

Select Summ ary. VIVA MEDICARE Plus Select (HMO) INTRODUCTION TO THE SUMMARY OF BENEFITS FOR. You have choices in your health care. INTRODUCTION TO THE SUMMARY OF BENEFITS FOR VIVA MEDICARE Plus January 1, 2013 - December 31, 2013 Central Alabama and Mobile Area Thank you for your interest in. Our plan is offered by Viva Health, Inc./,

More information

Summary of Benefits. for Anthem Medicare Preferred Premier (PPO)

Summary of Benefits. for Anthem Medicare Preferred Premier (PPO) Summary of Benefits for Available in Androscoggin, Cumberland, Franklin, Hancock, Kennebec, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, and Washington Counties, ME Anthem Blue

More information

VIVA MEDICARE Select (HMO)

VIVA MEDICARE Select (HMO) INTRODUCTION TO THE SUMMARY OF BENEFITS FOR VIVA MEDICARE January 1, 2014 - December 31, 2014 Central Alabama and Mobile Area Thank you for your interest in. Our plan is offered by Viva Health, Inc., which

More information

2012 Summary of Benefits

2012 Summary of Benefits North Carolina Network Private-Fee-For-Service 2012 N12SB42680102 Charlotte Rale SB Combo 001-002 001 - Patriot (PFFS) 002 - Patriot Plus (PFFS) Counties: Caswell, Cleveland, Durham, Granville, Guilford,

More information

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service) Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2011 December 31, 2011 Los Angeles County This publication is a supplement to the 2011 Positive (HMO SNP) Evidence

More information

HEALTH CARE BENEFITS YOU CAN COUNT ON. Retired Employees Health Program (REHP)

HEALTH CARE BENEFITS YOU CAN COUNT ON. Retired Employees Health Program (REHP) HEALTH CARE BENEFITS YOU CAN COUNT ON 2014 Retired Employees Health Program () PEBTF_2014 Thank you for your interest in Geisinger Gold Classic. Our plan is offered by Geisinger Health Plan/Geisinger Gold

More information

2012 Summary of Benefits

2012 Summary of Benefits 2012 Summary of Benefits San Francisco County, CA Benefits effective January 1, 2012 H0562 Health Net of California, Inc. Material ID # H0562_2012_0055 CMS Approved 08122011 SECTION I Introduction to

More information

(H7086) 2011 Summary of Benefits Special Needs Plan

(H7086) 2011 Summary of Benefits Special Needs Plan CommuniCare Advantage (HMO-SNP) (H7086) 2011 Summary of Benefits Special Needs Plan A Medicare Advantage organization with a Medicare contract. This information is available in a different format, including

More information

Summary Of Benefits January 1, December 31, 2014 Optima Medicare Optima Medicare Basic HMO Optima Medicare Enhanced HMO

Summary Of Benefits January 1, December 31, 2014 Optima Medicare Optima Medicare Basic HMO Optima Medicare Enhanced HMO Summary Of Benefits January 1, 2014 - December 31, 2014 Optima Medicare Optima Medicare Basic HMO Optima Medicare Enhanced HMO www.optimahealth.com/medicare Table of Contents 3 Letter from Michael Dudley,

More information

Section I Introduction to Summary of Benefits

Section I Introduction to Summary of Benefits Section I Introduction to Summary of Benefits Thank you for your interest in + Rx Classic (PPO) and. Our plans are offered by Regence BlueShield, a Medicare Advantage Preferred Provider Organization (PPO)

More information

Summary of Benefits For Advantage Health NY - SNP (HMO SNP)

Summary of Benefits For Advantage Health NY - SNP (HMO SNP) Summary of Benefits For Advantage Health NY - SNP January 1, 2014 December 31, 2014 Summary of Benefits, H2773-003 Advantage Health NY - SNP H2773_QHPNY0658 Accepted Advantage Health NY - SNP 1 SECTION

More information

Service limits for CADI and TBIW-NF and rate limits for assisted living / residential care through CADI for FY 2001

Service limits for CADI and TBIW-NF and rate limits for assisted living / residential care through CADI for FY 2001 #00-56-20 Bulletin July 28, 2000 444 Lafayette Rd. St. Paul, MN 55155 OF INTEREST TO! County Directors! Administrative Contacts: PAS, CADI, TBIW! Accounting Officers! County Public Health Nursing Services

More information

H1463-HMO 20 (HMO) HMO 20 (HMO) / HMO 20Rx (HMO) Summary of Benefits

H1463-HMO 20 (HMO) HMO 20 (HMO) / HMO 20Rx (HMO) Summary of Benefits H1463- / Summary of Benefits January 1, 2014 December 31, 2014 Call us 8 a.m. to 8 p.m. daily Toll-free 1-800-965-4022 TTY/TDD 1-800-526-0844 www.healthalliancemedicare.org med-hmo20sob-0713 H1463_14_8837

More information

HealthPartners Minnesota Senior Health Options (MSHO) (HMO SNP)

HealthPartners Minnesota Senior Health Options (MSHO) (HMO SNP) 2013 HealthPartners MSHO Summary of Benefits HealthPartners Minnesota Senior Health Options (MSHO) (HMO SNP) 420089 Individual MSHO (9/12) H2422_54016 CMS Accepted 9/1/2012 H2422 American Indian Language

More information

Good morning, Hopefully everyone had a wonderful Thanksgiving weekend.

Good morning, Hopefully everyone had a wonderful Thanksgiving weekend. From: Roxy Traxler To: Commissioner; Gary Kruggel Date: 11/27/2017 10:09 AM Subject: Board Update 11-27-17 Attachments: 2018-Preliminary-Levies_1.pdf; Computer Basic Flyer.pdf; data request Admin Asst.pdf

More information

June 16, 2016 Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care

June 16, 2016 Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care Advancing the Triple Aim Through Integrated Care June 16, 2016 Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care Disclosure Liz Cinqueonce reports no actual or potential conflicts

More information

SUMMARY OF BENEFITS. Medi-Pak Advantage MA (PFFS), Medi-Pak Advantage MA-PD (PFFS) Area 1

SUMMARY OF BENEFITS. Medi-Pak Advantage MA (PFFS), Medi-Pak Advantage MA-PD (PFFS) Area 1 SUMMARY OF BENEFITS MA, MA-PD Area 1 H4213_ADV_SOB_AREA1_COMBO Accepted Introduction to the Summary of Benefits for AR Blue Cross - MA and MA-PD January 1, 2014 - December 31, 2014 NORTHWEST, SOME EASTERN

More information

Julie Sabo PhD(c), APRN, CNS Advanced Practice Nurse Specialist

Julie Sabo PhD(c), APRN, CNS Advanced Practice Nurse Specialist Julie Sabo PhD(c), APRN, CNS Advanced Practice Nurse Specialist Background 2008 Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education Uniform model for regulation of

More information

Summary of Benefits. AARP MedicareComplete Choice (PPO) January 1, 2012 December 31, 2012 H

Summary of Benefits. AARP MedicareComplete Choice (PPO) January 1, 2012 December 31, 2012 H Summary of Benefits January 1, 2012 December 31, 2012 AARP MedicareComplete Choice H5516-001 North Carolina: Alamance, Chatham, Davidson, Davie, Forsyth, Guilford, Mecklenburg, Orange, Randolph, Rockingham,

More information

Summary of Benefits. Available in the Bronx, Kings, New York, Queens, and Richmond Counties in New York

Summary of Benefits. Available in the Bronx, Kings, New York, Queens, and Richmond Counties in New York Summary of Benefits for Empire MediBlue Plus SM (HMO) Available in the Bronx, Kings, New York, Queens, and Richmond Counties in New York This plan is an HMO plan with a Medicare contract. Services provided

More information

2014 Summary of Benefits. Health Net Seniority Plus (Employer HMO) Benefits effective January 1, 2014 and later (Medical plan 9XN)

2014 Summary of Benefits. Health Net Seniority Plus (Employer HMO) Benefits effective January 1, 2014 and later (Medical plan 9XN) 2014 Summary of Benefits Health Net Benefits effective January 1, 2014 and later (Medical plan 9XN) Material ID# H0562_EG_2014_0008_ Compliance Approved 08132013 Introduction to the Summary of Benefits

More information

SUMMARY OF BENEFITS. H5649_090412_1065_SB CMS Accepted

SUMMARY OF BENEFITS. H5649_090412_1065_SB CMS Accepted 2013 SUMMARY OF BENEFITS H5649_090412_1065_SB CMS Accepted Introduction Section I Introduction to the for MEDICARE PLAN (HMO), MEDI-MEDI PLAN (HMO SNP), and PREMIER PLAN (HMO) January 1 - December 31

More information

January 1, 2015 December 31, Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)

January 1, 2015 December 31, Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract) BLUECROSS BLUESHIELD SENIOR BLUE 601 (HMO), BLUECROSS BLUESHIELD SENIOR BLUE HMO SELECT (HMO) AND BLUECROSS BLUESHIELD SENIOR BLUE HMO 651 PARTD (HMO) (a Medicare Advantage Health Maintenance Organization

More information

UCare s Minnesota Senior Health Options (MSHO) (HMO SNP) 2018: Summary of Benefits

UCare s Minnesota Senior Health Options (MSHO) (HMO SNP) 2018: Summary of Benefits UCare s Minnesota Senior Health Options (MSHO) (HMO SNP) 2018: Summary of Benefits! This is a summary of health services covered by UCare s MSHO for 2018. Please read the Member Handbook for the full list

More information

Summary of Benefits. Medicare Advantage Plan (PPO) January 1, 2013 December 31, Medicare Solution. A UnitedHealthcare

Summary of Benefits. Medicare Advantage Plan (PPO) January 1, 2013 December 31, Medicare Solution. A UnitedHealthcare 2013 Summary of Benefits January 1, 2013 December 31, 2013 Medicare Advantage Plan (PPO) A UnitedHealthcare Medicare Solution The service area for this plan includes select counties in South Carolina.

More information

Summary of Benefits. Regence MedAdvantage + Rx Classic (PPO) GROUP RETIREE PLAN

Summary of Benefits. Regence MedAdvantage + Rx Classic (PPO) GROUP RETIREE PLAN 2013 Summary of Benefits GROUP RETIREE PLAN Regence MedAdvantage + Rx Classic (PPO) Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association ORMARXG-05761

More information

True Blue Special Needs Plan (HMO SNP)

True Blue Special Needs Plan (HMO SNP) True Blue Special Needs Plan (HMO SNP) 2012 Summary of Benefits You think about finding the perfect health insurance plan. We think about providing you with seamless service and affordable benefits. Serving

More information

Summary of Benefits for Blue Medicare Access Classic SM (Regional PPO)

Summary of Benefits for Blue Medicare Access Classic SM (Regional PPO) Summary of Benefits for Blue Medicare Access Classic SM (Regional PPO) Available in Ohio A health plan with a Medicare contract. Anthem Insurance Companies, Inc. (AICI) is the legal entity that has contracted

More information

Summary Of Benefits. WASHINGTON Pierce and Snohomish

Summary Of Benefits. WASHINGTON Pierce and Snohomish Summary Of Benefits WASHINGTON Pierce and Snohomish 2018 Molina Medicare Choice (HMO SNP) (800) 665-1029, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local time H5823_18_1099_0007_WAChoSB Accepted 9/26/2017

More information

Medicare Plus Blue SM Group PPO. Summary of Benefits. Michigan Public School Employees Retirement System

Medicare Plus Blue SM Group PPO. Summary of Benefits. Michigan Public School Employees Retirement System 2018 Medicare Plus Blue SM Group Summary of Benefits January 1, 2018 December 31, 2018 Michigan Public School Employees Retirement System www.bcbsm.com/mpsers This information is a summary document and

More information

Correction Notice. Health Partners Medicare Special Plan

Correction Notice. Health Partners Medicare Special Plan Correction Notice Special Plan Following are corrections that apply to both the English and Spanish versions of the 2015 for Special (HMO SNP): Original Information Page 1, under the heading SECTIONS IN

More information

VIVA MEDICARE Plus Rx

VIVA MEDICARE Plus Rx Extra Value Summary of s 2011 introduction to the summary of benefits for VIVA MEDICARE Plus Rx Thank you for your interest in. Our plan is offered by Vi va Health, Inc./Vi va Medicare Plus, a Medicare

More information

Summary of Benefits. Available in Delaware, Nassau, and Rockland Counties, NY

Summary of Benefits. Available in Delaware, Nassau, and Rockland Counties, NY Summary of Benefits for SM Available in Delaware, Nassau, and Rockland Counties, NY Empire BlueCross BlueShield is a Health plan with a Medicare contract. Services provided by Empire HealthChoice Assurance,

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Jade (HMO SNP) Kern, Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0175 CMS Accepted 09082015

More information

special needs plan (hmo snp) MEDICARE advantage plan summary of benefits Serving Members in Douglas & Klamath Counties

special needs plan (hmo snp) MEDICARE advantage plan summary of benefits Serving Members in Douglas & Klamath Counties special needs plan (hmo snp) 2017 MEDICARE advantage plan summary of benefits Serving Members in Douglas & Klamath Counties Table of Contents About the Summary of Benefits... 2 Who Can Join?... 2 Which

More information

2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1

2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1 2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1 Hawaii, Honolulu, Kalawao, Kauai and Maui counties MEDICAL COVERAGE Monthly Plan Premium $0 Calendar Year Out-Of-Pocket Maximum1 $1,200 Inpatient

More information

2013 Summary of Benefits Humana Medicare Employer RPPO

2013 Summary of Benefits Humana Medicare Employer RPPO 2013 Summary of Benefits Employer RPPO RPPO 079/631 Loudoun County Public Schools Y0040_GHA0B4IHH13 PPO 079/631 Thank you for your interest in the Employer Regional PPO Plan. This plan is offered by Humana

More information

UCare Connect (Special Needs BasicCare) Enrollment Form

UCare Connect (Special Needs BasicCare) Enrollment Form UCare Connect (Special Needs BasicCare) Enrollment Form UCare Connect Enrollment Telephone Numbers 612-676-3554 or 1-800-707-1711 toll free. TTY for the hearing impaired at 612-676-6810 or 1-800-688-2534

More information

INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS

INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS January 1, 2015 - December 31, 2015 CARE1ST HEALTH PLAN California: Fresno, Merced, Stanislaus and San Joaquin Counties H5928_15_029_SB_CTCA_2

More information

Select Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES

Select Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2015 - December 31, 2015 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what

More information

Summary of Benefits Report SENIOR CARE PLUS: VALUE BASIC PLAN (HMO)-009 January 1, 2015 December 31, 2015 WASHOE COUNTY, NEVADA

Summary of Benefits Report SENIOR CARE PLUS: VALUE BASIC PLAN (HMO)-009 January 1, 2015 December 31, 2015 WASHOE COUNTY, NEVADA SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare).

More information

2017 Summary of Benefits

2017 Summary of Benefits H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December

More information

HMO Basic (HMO) / HMO 40 (HMO) / HMO 20 (HMO) Summary of Benefits

HMO Basic (HMO) / HMO 40 (HMO) / HMO 20 (HMO) Summary of Benefits / / Summary of Benefits January 1, 2015 December 31, 2015 Call toll-free 1-800-965-4022 8 a.m. to 8 p.m. daily October 1 to February 15 and 8 a.m. to 8 p.m. weekdays the rest of the year. TTY/TDD 711 HealthAllianceMedicare.org

More information

Summary Of Benefits. FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk

Summary Of Benefits. FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk Summary Of Benefits FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk 2018 Molina Medicare Options Plus (HMO SNP) (866) 553-9494, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local

More information

Our service area includes the following county in: Delaware: New Castle.

Our service area includes the following county in: Delaware: New Castle. 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H3113-011 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

Summary Of Benefits. Molina Medicare Options Plus (HMO SNP) (866) , TTY/TDD days a week, 8 a.m. 8 p.m. local time

Summary Of Benefits. Molina Medicare Options Plus (HMO SNP) (866) , TTY/TDD days a week, 8 a.m. 8 p.m. local time Summary Of Benefits OHIO Brown, Butler, Clark, Clermont, Clinton, Columbiana, Delaware, Fairfield, Fayette, Franklin, Greene, Hamilton, Highland, Hocking, Lake, Madison, Miami, Montgomery, Morrow, Perry,

More information

Explorer Plan (HMO-POS) SunSaver Plan (HMO-POS)

Explorer Plan (HMO-POS) SunSaver Plan (HMO-POS) January 1, 2016 December 31, 2016 Explorer Plan SunSaver Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

More information

MEDICARE By Peter G. Pan

MEDICARE By Peter G. Pan Wendell K. Kimura Acting Director Research (808) 587-0666 Revisor (808) 587-0670 Fax (808) 587-0681 LEGISLATIVE REFERENCE BUREAU State of Hawaii State Capitol Honolulu, Hawaii 96813 No. 02-13 October 7,

More information

Get More Than. Original Medicare. Summary of Benefits MA Special Needs Plan (HMO SNP) 014. H5826_MA_193_2016_v_01_SB014 Accepted.

Get More Than. Original Medicare. Summary of Benefits MA Special Needs Plan (HMO SNP) 014. H5826_MA_193_2016_v_01_SB014 Accepted. Get More Than Original Medicare Offered by 2016 Summary of Benefits MA Special Needs Plan (HMO SNP) 014 H5826_MA_193_2016_v_01_SB014 Accepted Section I Introduction to the Summary of Benefits for Community

More information

Explorer Plan (HMO-POS) SunSaver Plan (HMO-POS)

Explorer Plan (HMO-POS) SunSaver Plan (HMO-POS) January 1, 2015 December 31, 2015 Explorer Plan SunSaver Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

More information

2013 SUMMARY OF BENEFITS Brand New Day HMO D Special Needs Plan (SNP) (For Members with Medicare & Medi-Cal)

2013 SUMMARY OF BENEFITS Brand New Day HMO D Special Needs Plan (SNP) (For Members with Medicare & Medi-Cal) 2013 SUMMARY OF BENEFITS Brand New Day HMO D Special Needs Plan (SNP) (For Members with Medicare & Medi-Cal) H0838_2013SB_024_File & Use: Contract#H0838 SECTION I - INTRODUCTION TO SUMMARY

More information

Our service area includes these counties in: Arizona: Apache, Coconino, Maricopa, Mohave, Navajo, Pinal, Yavapai.

Our service area includes these counties in: Arizona: Apache, Coconino, Maricopa, Mohave, Navajo, Pinal, Yavapai. 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete ONE (HMO SNP) H0321-004 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket

More information

Our service area includes these counties in: Florida: Broward, Miami-Dade.

Our service area includes these counties in: Florida: Broward, Miami-Dade. 2018 SUMMARY OF BENEFITS Overview of your plan Preferred Medicare Assist (HMO SNP) H1045-012 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service

More information

Summary of Benefits 2018

Summary of Benefits 2018 SM Summary of Benefits 2018 bluecareplus.bcbst.com H3259_18_SB Accepted 08282017 This is a summary of drug and health services covered by BlueCare Plus (HMO SNP) SM health plan January 1, 2018 - December

More information

Signal Advantage HMO (HMO) Summary of Benefits

Signal Advantage HMO (HMO) Summary of Benefits Signal Advantage HMO (HMO) Summary of Benefits January 1, 2016 December 31, 2016 The provider network may change at any time. You will receive notice when necessary. This information is available for free

More information

Introduction to Summary of Benefits

Introduction to Summary of Benefits 2011 Summary of Benefits H8468 Reserve SB 2011 10256_1 CMS Approved 9/15/10 RESERVE (MSA) Thank you for your interest in Geisinger Gold Reserve (MSA). Our plan is offered by GEISINGER INDEMNITY INSURANCE

More information

Our service area includes the following county in: Florida: Miami-Dade.

Our service area includes the following county in: Florida: Miami-Dade. 2018 SUMMARY OF BENEFITS Overview of your plan Medica HealthCare Plans MedicareMax (HMO) H5420-001 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

Special Public Notice ISSUED: 01 July 2014 EXPIRES: 31 December SECTION: Clean Water Act 10 - Rivers and Harbors Act MVP

Special Public Notice ISSUED: 01 July 2014 EXPIRES: 31 December SECTION: Clean Water Act 10 - Rivers and Harbors Act MVP Special Public Notice ISSUED: 01 July 2014 EXPIRES: 31 December 2014 2014-01870-MVP SECTION: 404 - Clean Water Act 10 - Rivers and Harbors Act Information regarding Department of the Army permits for clean

More information

SUMMARY OF BENEFITS. Cigna-HealthSpring. Advantage SMS (HMO) H January 1, December 31, Cigna H4407_16_32690 Accepted

SUMMARY OF BENEFITS. Cigna-HealthSpring. Advantage SMS (HMO) H January 1, December 31, Cigna H4407_16_32690 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Advantage SMS (HMO) H4407-011 2015 Cigna H4407_16_32690 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet

More information

Summary Of Benefits. IDAHO Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls

Summary Of Benefits. IDAHO Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls Summary Of Benefits IDAHO Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls 2018 Molina Medicare Options Plus (HMO SNP) (844) 239-4913, TTY/TDD 711 7 days a week, 8

More information

Summary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP)

Summary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP) Summary of Benefits for Available in: Select Counties* in Maine *See Page 2 for a list of counties. Plan year: January 1, 2018 December 31, 2018 In this section, you ll learn about some of the benefits

More information

Our service area includes these counties in:

Our service area includes these counties in: 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H0432-009 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

2012 Summary of Benefits WindsorSterling Silver Connect Plan (PFFS)

2012 Summary of Benefits WindsorSterling Silver Connect Plan (PFFS) 2012 Summary of s 120410-00 120408-00 Y0060_H3410_MSUM008 Y0060_MSUM005 0811 CMS Approved MMDDYYYY 09262011 Section I Introduction to Summary of s Thank you for your interest in. Our plan is offered by

More information

Summary Of Benefits. NEW MEXICO Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, San Juan, Sandoval, Santa Fe, Sierra, Torrance, and Valencia

Summary Of Benefits. NEW MEXICO Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, San Juan, Sandoval, Santa Fe, Sierra, Torrance, and Valencia Summary Of Benefits NEW MEXICO Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, San Juan, Sandoval, Santa Fe, Sierra, Torrance, and Valencia 2018 Molina Medicare Options Plus (HMO SNP) (866) 440-0127,

More information

Our service area includes these counties in: Texas: Aransas, Kleberg, Nueces, San Patricio.

Our service area includes these counties in: Texas: Aransas, Kleberg, Nueces, San Patricio. 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete Focus (HMO SNP) H4527-004 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

Summary Of Benefits. CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego

Summary Of Benefits. CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego Summary Of Benefits CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego 2018 Molina Medicare Options Plus (HMO SNP) (800) 665-0898, TTY/TDD 711 7 days a week,

More information

Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO)

Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) January 1, 2016 December 31, 2016 Classic Plan Value Plan Rewards Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover

More information

Summary of Benefits. New Mexico Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, Sandoval, San Juan, Santa Fe, Sierra, Torrance and Valencia

Summary of Benefits. New Mexico Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, Sandoval, San Juan, Santa Fe, Sierra, Torrance and Valencia Summary of Benefits New Mexico Bernalillo, Chaves, Dona Ana, Luna, McKinley, Otero, Sandoval, San Juan, Santa Fe, Sierra, Torrance and Valencia 2016 Molina Medicare Options Plus HMO SNP Member Services

More information

DeanCare Gold (Cost) 2014

DeanCare Gold (Cost) 2014 A subsidiary of Dean Health Insurance, Inc. (Cost) 2014 Dean Health Plan, Inc. 1277 Deming Way Madison, Wisconsin 5 3717 (8 8 8)422-3326 T T Y Users Dial 711 2013 Dean Health Plan, Inc. H5264_2030v4_0713

More information

Our service area includes Florida.

Our service area includes Florida. 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP) R7444-013 Look inside to learn more about the health services and drug coverages the plan provides.

More information

Our service area includes these counties in: North Carolina: Durham, Wake.

Our service area includes these counties in: North Carolina: Durham, Wake. 2018 SUMMARY OF BENEFITS Overview of your plan AARP MedicareComplete (HMO) H5253-039 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service or go

More information

Our service area includes these counties in:

Our service area includes these counties in: 2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Nursing Home Plan (HMO SNP) H5253-042 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer

More information

2018 Summary of Benefits

2018 Summary of Benefits 2018 Summary of Benefits H5209-004_MDASB 9-13-17 Accepted 9/18/2018 DHS Approved 09/13/2017 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP)

More information

Cigna Health and Life Insurance Company. Plan Benefits. Unlimited. Unlimited. Not applicable. Not applicable. Not applicable

Cigna Health and Life Insurance Company. Plan Benefits. Unlimited. Unlimited. Not applicable. Not applicable. Not applicable SUMMARY OF BENEFITS Client Name: Washington County Public Schools Benefit Option Name: Medicare Supplement Effective: July 1, 2018 through June 30, 2019 1 Benefit Description Lifetime Maximum Applies to

More information

City of Sacramento 01/01/2019 Renewal. $100 Per Admission

City of Sacramento 01/01/2019 Renewal. $100 Per Admission City of Sacramento 01/01/2019 Renewal Kaiser Permanente 2019 Senior Advantage (HMO) Group Plan with Part D Benefits Summary Your employer joins with Kaiser Permanente to offer you the select benefits listed

More information

Bulletin. CY2017 Mental Health Grants Fiscal Reporting Information TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE OF INTEREST TO

Bulletin. CY2017 Mental Health Grants Fiscal Reporting Information TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE OF INTEREST TO Bulletin NUMBER 17-32-13 DATE April 24, 2017 OF INTEREST TO County Directors Social Services Supervisors and Staff Fiscal Supervisors ACTION/DUE DATE Please review and note changes for 2017. EXPIRATION

More information

Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC.

Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC. Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network Providers Annual Maximum Out-of-Pocket Amount $2,500 The maximum out-of-pocket limit applies to all

More information

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits 2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits For Oregon counties: Clackamas, Clatsop, Columbia, Jackson, Josephine, Multnomah, Tillamook, Washington and Yamhill H5859_1099_CO_1018 CMS

More information

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service) Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2015 December 31, 2015 Los Angeles County This publication is a supplement to the 2015 Evidence of Coverage and

More information

OF BENEFITS. Cigna-HealthSpring TotalCare (HMO SNP) H Cigna H3949_15_19921 Accepted

OF BENEFITS. Cigna-HealthSpring TotalCare (HMO SNP) H Cigna H3949_15_19921 Accepted agesummary OF BENEFITS Cover erage Cigna-HealthSpring TotalCare (HMO SNP) H3949-009 2014 Cigna H3949_15_19921 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get

More information

Extra Value Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES

Extra Value Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2016 - December 31, 2016 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what

More information