WPS Medicare Supplement Plans

Size: px
Start display at page:

Download "WPS Medicare Supplement Plans"

Transcription

1 WPS Medicare Supplement Plans Now including plans with a three-year rate guarantee!1 Effective January 1, 2016 Outline of Medicare Supplement Coverage Benefit Plans A, C, F, K, L, M, and N for Iowa Residents Underwritten by The EPIC Life Insurance Company 1 See page 5 for details.

2 WPS Health Insurance Outline of Medicare Supplement Coverage This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. We are currently offering Medicare Supplement Plans A, C, F, K, L, M, and N. Basic Benefits Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments. Blood: First 3 pints of blood each year. Hospice: Part A coinsurance A B C D F F* G K L M N 100% Basic, and 100% Part B coinsurance 100% Basic, and 100% Part B coinsurance 100% Basic, and 100% Part B coinsurance 100% Basic, and 100% Part B coinsurance 100% Basic, and 100% Part B coinsurance 100% Basic, and 100% Part B coinsurance Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Hospitalization and preventive care paid at 100%; other basic benefits paid at 75% 100% Basic, and 100% Part B coinsurance 100% Basic and 100% part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing Facility Skilled Nursing Facility Skilled Nursing Facility Skilled Nursing Facility 50% Skilled Nursing Facility 75% Skilled Nursing Facility Skilled Nursing Facility Skilled Nursing Facility Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible 50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A Deductible Part B Deductible Part B Deductible Part B Excess (100%) Part B Excess (100%) Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Out-of-pocket limit $4,940; paid at 100% after limit reached Out-of-pocket limit $2,470; paid at 100% after limit reached *Plan F also has an option called a high deductible Plan F. This option is not currently offered by WPS. 2

3 Medicare alone is not enough. That s why there are WPS Medicare Supplement Plans. Medicare covers a lot of health care expenses, but it doesn t pay for all of them. There are deductibles and coinsurance you have to pay before Medicare pays its share. And there s always a chance that a serious illness or injury could exhaust some of your Medicare benefits. So what can you do to get the health care you need and protect your retirement savings? Sign up for a WPS Medicare supplement plan. Enjoy dependable protection from a local Midwestern not-for-profit health insurer. Founded in Wisconsin in 1946, WPS Health Insurance has helped people with their health care bills for more than 65 years. We ve been serving people on Medicare since Medicare began. When you choose WPS, our years of experience and expertise are on your side. Serving members in several Midwestern states, we keep our business close to home so that we re local wherever we go. Our members enjoy: Outstanding coverage and stable rates Freedom to choose your own doctors Prompt, friendly service based right next door in Wisconsin What's more, 98% of our Medicare supplement members say they would recommend WPS to a friend or family member. 1 Contents WPS Health Insurance Outline of Medicare Supplement Coverage 2 About WPS Health Insurance 3 Plans K, L 4 9 Important information & disclosures 10 Plans A, C, F, M, and N Renewal terms 21 Medicare preventive care & screening services 22 Named one of the "World's Most Ethical Companies" six years in a row. Ethics and integrity are at the core of our values, and it shows in everything we do. That's why in 2015, the international Ethisphere Institute named WPS one of the "World's Most Ethical Companies" for the sixth year in a row. 2 We re eager to put our good values to work for you. To learn more about the World s Most Ethical Companies designation, please visit WPS Health Insurance information 23 IMPORTANT: If there s ever a discrepancy between the policy and this outline of coverage, the policy has final authority. 1 WPS Customer Satisfaction Survey, World's Most Ethical Companies Ranking, Ethisphere Institute, 3

4 Medicare Part B Example WPS 10% 50% Cost-Sharing Plan Medicare 80% Patient 10% 25% Cost-Sharing Plan Medicare 80% WPS 15% Patient 5% Cost-sharing plans K and L: Choose your share of the pie. WPS Medicare Plans K and L offer two different designs: a 25% cost-sharing plan and a 50% cost-sharing plan. The percentages reflect how much of your covered medical expenses you pay after Medicare pays its share. And if you hit your limit for out-of-pocket expenses, WPS pays everything beyond that for all Medicare-approved benefits. 50% cost-sharing plan: Plan K If you want a low, low premium, you can select the 50% cost-sharing plan. For this plan, Medicare Part B pays its 80% following the deductible for your covered medical expenses. Then, you split the remainder of the bill evenly with WPS. This means that you pay about 10 cents of every dollar of your total covered health care bill and WPS picks up the other 10. For Part A, WPS pays half of the deductible. After the deductible, the hospital charges are generally covered at 100%. 25% cost-sharing plan: Plan L If you choose the 25% cost-sharing plan, Medicare Part B pays its 80% following the deductible and you split the remainder of the bill with WPS: WPS pays three-fourths and you pay one-fourth. If you do the math, you ll see that this requires you to pay only about five cents of every dollar on your total covered medical bill. For Part A, WPS pays 75% of the deductible. After the deductible, the hospital charges are generally covered at 100%. 4

5 Three-year rate guarantee keeps your premium predictable. When you budget your monthly expenses, it s nice to have some things that remain constant. Food and gas prices may swing up and down, but your Medicare Plan K or L premium will stay the same for three full years! 3 Take the money you won t be spending on health plan increases in the second and third years and put it away for something special. Caps on costs save you money. When you consider that Medicare has put caps on what a health care provider can charge you for many procedures, the risk in assuming 25% or 50% of the remaining costs is small. For example, if you need your gall bladder removed, that sounds expensive, right? Think again. What about a a visit to the ER? That s more affordable than you d think, too. Check out the chart for some costs on common procedures as submitted in Iowa in Procedure Removal of gall bladder using a laparoscope CPT Code Amount billed to Medicare Medicare allowed charge The amount you d pay on a 25% cost-sharing plan $3, $ $33.41 $66.82 Emergency department visit $1, $ $8.08 $16.16 Tissue exam by pathologist $1, $ $5.02 $10.04 The amount you d pay on a 50% cost-sharing plan 2 1 This is the most recent data available. 2 You must pay the Medicare Part B deductible first, then this amount. Source: America s Health Insurance Plans. Survey of Charges Billed by Out-of-Network Providers: A Hidden Threat to Affordability. Web. 15 July The premium for WPS Medicare Plans K and L is guaranteed for three years unless you change benefits, your residence changes and you move into a new rating area, or significant changes to state and/or federal health insurance mandates require WPS to change your benefits. 5

6 Monthly Premium Rates Plan K and L - Effective January 1, 2016 Rates for all zip codes MALE AGE PLAN K PLAN L 65 $76.86 $ $80.73 $ $84.61 $ $88.50 $ $92.37 $ $96.27 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ FEMALE AGE PLAN K PLAN L 65 $68.16 $ $71.59 $ $75.03 $ $78.48 $ $81.92 $ $85.37 $ $88.80 $ $92.24 $ $95.68 $ $99.14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ The rates shown above are based on attained ages. To calculate Annual, Semi-Annual, or Quarterly premiums, multiply the Monthly Premium amount by 12, 6, and 3, respectively. All are available with the ACH option. We offer a 7% discount if two members of the same household enroll in a WPS Medicare supplement. To calculate, multiply your final rate by If a member requests to pay via check, Monthly, Quarterly, Semi-Annual and Annual payment options are available. A $5 billing fee is charged per bill for Monthly, Quarterly, and Semi-Annual direct bill options. 6

7 MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. PLANS K & L Services Medicare Pays Plan K Pays You Pay Plan L Pays You Pay HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies First 60 days 61st to 90th day All but $1,260 All but $315 a day $630 (50% of Part A $315 a day $630 (50% of Part A $945 (75% of Part A $315 a day $315 (25% of Part A 91st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days All but $630 a day $630 a day 100% of Medicare eligible expenses $630 a day $100% of Medicare eligible expenses SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital First 20 days All approved amounts 21st to 100th day All but $ a day Up to $78.75 a day Up to $78.75 a day Up to $ a day Up to $39.38 a day 101st day and after BLOOD First 3 pints Additional amounts 100% 50% 50% 75% 25% With Plan L you will pay ¼ of the cost sharing of some covered services until you reach the annual out-of-packet limit of $2,470 each calendar year. With Plan K you will pay ½ the cost sharing of some covered services until you reach the annual out-of-pocket limit of $4,940 each calendar year. The amounts that count toward your annual limit are noted with diamonds ( ) in the chart above. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called Excess Charges ) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. 7

8 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLANS K & L Services Medicare Pays Plan K Pays You Pay Plan L Pays You Pay HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to All but very limited copayment/ coinsurance for 50% of Medicare Copayment/ 50% of Medicare Copayment/ 75% of Medicare Copayment/ 25% of Medicare Copayment/ receive these services outpatient drugs and inpatient respite care MEDICAL EXPENSES In or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare-approved amounts* Preventive benefits for Medicarecovered services Generally 75% of Medicareapproved amounts Remainder of Medicare-approved amounts All costs above Medicare-approved amounts Remainder of Medicareapproved amounts All costs above Medicareapproved amounts Remainder of Medicare-approved amounts PART B EXCESS CHARGES (Above Medicare-approved amounts) Generally 80% Generally 10% Generally 10% (and they do not count toward annual outof-pocket limit of $4,940) Generally 15% Generally 5% (and they do not count toward annual out-of-pocket limit of $2,470) With Plan L you will pay ¼ of the cost sharing of some covered services until you reach the annual out-of-packet limit of $2,470 each calendar year. With Plan K you will pay ½ the cost sharing of some covered services until you reach the annual out-of-pocket limit of $4,940 each calendar year. The amounts that count toward your annual limit are noted with diamonds ( ) in the chart above. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called Excess Charges ) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. 8

9 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLANS K & L Services Medicare Pays Plan K Pays You Pay Plan L Pays You Pay BLOOD First 3 pints 50% 50% 75% 25% Next $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts Generally 80% Generally 10% Generally 10% Generally 15% Generally 5% CLINICAL LABORATORY SERVICES Tests for diagnostic services 100% Medicare Parts A & B HOME HEALTH CARE (Medicare-approved Services) Medically necessary skilled care services and medical supplies 100% Durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts 80% 10% 10% 15% 5% With Plan L you will pay ¼ of the cost sharing of some covered services until you reach the annual out-of-packet limit of $2,470 each calendar year. With Plan K you will pay ½ the cost sharing of some covered services until you reach the annual out-of-pocket limit of $4,940 each calendar year. The amounts that count toward your annual limit are noted with diamonds ( ) in the chart above. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called Excess Charges ) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. 9

10 Neither WPS Health Insurance, EPIC Life Insurance nor its agents are connected with the federal Medicare program. 10 Important information and disclosures Premium Information Outside of the rate guarantee period we can only raise your premium if we raise the premium for all policies like yours in this state or you enter a new age category. During your rate guarantee period (three years for K&L plans and one year for all others) your rate will not change unless your residence changes such that you move to a new rating area, or significant changes to state and/or federal health insurance mandates require WPS to change your benefits. Disclosures Use this outline to compare benefits and premiums among policies, certificates, and contracts. Read your policy very carefully This is only an outline describing your policy s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company. Right to return policy If you find that you re not satisfied with your policy, you may return it to: WPS Health Insurance, P.O. Box 8190, Madison, WI If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments directly to you. Policy replacement If you re replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. Notice This policy may not fully cover all of your medical costs. WPS Health Insurance, EPIC Life Insurance, and their agents are not connected with Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security office or consult Medicare and You for more details. Complete answers are very important When you fill out the application for the new policy, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. Review the application carefully before you sign it. Be certain that all information has been properly recorded.

11 Plans A, C, F, M, and N: Comprehensive coverage. These plans cover your Medicare Part A (Hospitalization) and Part B (Medical) coinsurance costs you would otherwise have to pay out of your own pocket. But that s just the beginning. WPS Medicare supplement plans pay for a variety of important services, including: Hospitalization, skilled nursing care, and home health care services Medical and surgical services and supplies X-rays, mammograms, and lab tests Licensed ambulance services Physical, radiation, and speech therapy Equipment and certain supplies to treat diabetes These plans also offer extra features that you won t get from WPS Medicare Plans K or L. WPS Medicare Plans A, C, F, M, and N provide FREE access to amenities such as treadmills, weights, heated pools, and fitness classes that are included with a basic fitness center membership through the award-winning SilverSneakers Fitness Program. Your WPS ID card also entitles you to discounts on eye care, eyewear, and hearing aids accessible at major retailers nationwide.1 1 Fitness program, vision and hearing discount programs are not part of the insurance policy and are offered at no additional charge. SilverSneakers is a registered trademark of Healthways, Inc. 11

12 Monthly Premium Rates Effective January 1, 2016 Rates for all zip codes MALE AGE PLAN A PLAN C PLAN F PLAN M PLAN N 65 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ FEMALE AGE PLAN A PLAN C PLAN F PLAN M PLAN N 65 $93.71 $ $ $ $ $98.45 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ The rates shown above are based on attained ages. To calculate Annual, Semi-Annual, or Quarterly premiums, multiply the Monthly Premium amount by 12, 6, and 3, respectively. All are available with the ACH option. We offer a 7% discount if two members of the same household enroll in a WPS Medicare Supplement plan. To calculate, multiply your final rate by If a member requests to pay via check, Monthly, Quarterly, Semi-Annual and Annual payment options are available. A $5 billing fee is charged per bill for Monthly, Quarterly, and Semi-Annual direct bill options. 12

13 MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. PLAN A Services Medicare Pays Plan A Pays You Pay HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies First 60 days All but $1,260 $1,260 (Part A 61st to 90th day All but $315 a day $315 a day 91st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days All but $630 a day $630 a day 100% of Medicare eligible expenses SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital. First 20 days All approved amounts 21st to 100th day All but $ a day Up to $ a day 101st day and after BLOOD First 3 pints Additional amounts 100% 3 pints HOSPICE CARE You must meet Medicare's requirements, Including a doctor's certification of terminal illness. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare Copayment/ 13

14 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLAN A Services Medicare Pays Plan A Pays You Pay MEDICAL EXPENSES In or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts PART B EXCESS CHARGES (Above Medicare-approved amounts) BLOOD First 3 pints Next $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts Generally 80% Generally 20% 80% 20% CLINICAL LABORATORY SERVICES Tests for diagnostic services 100% Medicare Parts A & B HOME HEALTH CARE (Medicare-approved services) Medically necessary skilled care services and medical supplies 100% Durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts 80% 20% 14

15 MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. PLANS C & F Services Medicare Pays Plan C Pays You Pay Plan F Pays You Pay HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies First 60 days 61st to 90th day All but $1,260 All but $315 a day $1,260 (Part A $315 a day $1,260 (Part A $315 a day 91st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days All but $630 a day $630 a day 100% of Medicare eligible expenses $630 a day 100% of Medicare eligible expenses SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital. First 20 days 21st to 100th day All approved amounts All but $ a day Up to $ a day Up to $ a day 101st day and after BLOOD First 3 pints Additional amounts 100% 100% 100% HOSPICE CARE You must meet Medicare's requirements, Including a doctor's certification of terminal illness. All but very limited Copayment/ for outpatient drugs and inpatient respite care Medicare Copayment/ Medicare Copayment/ 15

16 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLANS C & F Services Medicare Pays Plan C Pays You Pay Plan F Pays You Pay MEDICAL EXPENSES In or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts Generally 80% Generally 20% Generally 20% PART B EXCESS CHARGES (Above Medicare-approved amounts) 100% BLOOD First 3 pints Next $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts 80% 100% 20% 100% 20% CLINICAL LABORATORY SERVICES Tests for diagnostic services 100% Medicare Parts A & B HOME HEALTH CARE (Medicare-approved services) Medically necessary skilled care 100% services and medical supplies Durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts 80% 20% 20% 16

17 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR PLANS C & F Other Benefits Not Covered by Medicare Services Medicare pays Plan C Pays You Pay Plan F Pays You Pay FOREIGN TRAVEL Not Covered by Medicare Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $250 $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 17

18 MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. PLANS M & N Services Medicare Pays Plan M Pays You Pay Plan N Pays You Pay HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies First 60 days 61st to 90th day All but $1,260 All but $315 a day $630 (50% of Part A $315 a day $630 (50% of Part A $1,260 (Part A $315 a day 91st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days All but $630 a day $630 a day 100% of Medicare eligible expenses $630 a day 100% of Medicare eligible expenses SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st to 100th day All approved amounts All but $ a day Up to $ a day Up to $ a day 101st day and after BLOOD First 3 pints Additional amounts 100% 100% 100% HOSPICE CARE You must meet Medicare's requirements, Including a doctor's certification of terminal illness All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care Medicare Copayment/ Medicare Copayment/ 18

19 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLANS M & N Services Medicare Pays Plan M Pays You Pay Plan N Pays You Pay MEDICAL EXPENSES In or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts Generally 80% Generally 20% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if you are admitted to any hospital & the emergency visit is covered as a Medicare Part A expense. PART B EXCESS CHARGES (Above Medicare-approved amounts) 100% BLOOD First 3 pints Next $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts 80% 20% CLINICAL LABORATORY SERVICES Tests for diagnostic services 100% 20% Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if you are admitted to any hospital & the emergency visit is covered as a Medicare Part A expense. 19

20 MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR *Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year. PLANS M & N Medicare Parts A & B Services Medicare Pays Plan M Pays You Pay Plan N Pays You Pay HOME HEALTH CARE (Medicare-approved services) Medically necessary skilled care services and medical supplies Durable medical equipment First $147 of Medicare-approved amounts* Remainder of Medicare-approved amounts Other Benefits Not Covered by Medicare 20% Services Medicare Pays Plan M Pays You Pay Plan N Pays You Pay FOREIGN TRAVEL Not Covered by Medicare Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum 20% 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum 20

21 Renewal terms. For your WPS Medicare supplement coverage to continue, we must receive your premium as required by the policy. We ll only send one bill to notify you when your premium is due. (If you re paying through our Automated Clearing House program, no bills are sent.) Your grace period for paying the premium is: 31 days after the premium due date when you pay quarterly, semiannually, or annually 10 days after the premium due date when you pay monthly Your premium is subject to change at our option. Any change in your WPS Medicare supplement premium will apply to all policyholders with identical policies who live in the same ZIP code, and who are the same age as you. You can terminate your coverage at any time by writing to us prior to your requested termination date. Convenient payment options. Automatic premium payment. With our Automated Clearing House (ACH) service, you can have your bank automatically transfer the exact amount of your premium payment to WPS each time it s due. It s a safe and easy way to pay your premium. You even have the choice of paying your premium monthly, quarterly, semiannually, or annually! To take advantage of ACH, fill out the Automatic Withdrawal Payment Authorization section of your WPS Medicare Supplement Enrollment Application. Attach a voided check or a savings deposit slip to your application. Your bank will electronically transfer the exact amount of your premium on the day of the month that s convenient for you. General information. This outline of coverage provides only a general description of WPS Medicare supplement benefits. You can find a more detailed description of WPS Medicare supplement coverage in the policy. The policy will be issued to you upon approval for coverage under the WPS Medicare supplement plan. Coverage is subject to all terms and conditions of the policy. We ve added the subject headings in this outline of coverage for easier reading and quick reference. These headings aren t part of the description of coverage, and aren t to be used in determining applicable limitations and exclusions. This outline of coverage doesn t give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare & You for more details. To receive a copy of this handbook, call Credit/debit card payment. If you choose to pay by credit/debit card, your initial premium amount will be charged to your card once your application has been approved. You can also pay your premium monthly, quarterly, semiannually, or annually. Simply complete the Credit/Debit Card Authorization section of your WPS Medicare Supplement Enrollment Application. Direct billing. This is the traditional method of paying premium. If you choose to pay through direct billing, WPS will mail subsequent premium notices to you according to the payment schedule you select monthly, quarterly, semiannually, or annually. 1 1 The rates in this brochure reflect a discount for using Automated Clearing House, debit card, credit card, automated bank draft, or annual billing by mail. Rates will be $5.00 higher per billing period for members who select direct billing on a monthly, quarterly, or semiannual basis. 21

22 Medicare preventive care and screening services. Medicare covers a number of preventive and screening services under Part B. The benefits under Medicare may be subject to certain age, health risk, or frequency requirements. Many of these services have no deductible or copayment. However, some services require that you pay a deductible, a copayment, or coinsurance. Your WPS Medicare supplement will help with the remaining costs associated with some of these services, such as: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests HIV screening Mammograms (screening) Medical nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings Sexually transmitted infections screening & counseling Shots: Flu shots Hepatitis B shots Pneumococcal shots Tobacco use cessation counseling Yearly "Wellness" visit All WPS Medicare supplement plans cover 100% of the Medicare Part B preventive services that carry a copayment or coinsurance. Some services may be subject to the Part B calendar-year deductible. In addition, your health care provider may not accept Medicare assignment. 22

23 WPS Health Insurance delivers the coverage you need plus peace of mind. Every WPS Health Insurance Medicare supplement plan gives you coverage to help pay for what Medicare doesn t. Protect your retirement savings and rest easy knowing that you re covered! Get your Medicare supplement from WPS and enjoy the peace of mind that comes with: Comprehensive coverage that helps fill the gaps in Medicare. Every WPS Medicare supplement policy begins with an excellent core of benefits. You choose which plan you want: A, C, F, K, L, M, or N. See more detailed descriptions of WPS Medicare supplement plans on pages 4 9 and Freedom to choose your own doctors and hospitals that accept Medicare anywhere in the U.S. With a WPS Medicare supplement, you can keep the same doctor you ve been seeing for years. Or, you can select a new doctor at any time. You have complete freedom to choose your health care providers. And if you move, your WPS Medicare supplement coverage moves with you anywhere in the U.S. Coverage that keeps pace with Medicare. Each time the Centers for Medicare & Medicaid Services (CMS) increases the Medicare deductibles, your WPS Medicare supplement benefits adjust to cover the increase. You can feel secure in knowing your plan will always remain current with Medicare. Our household discount can save you money. WPS offers a 7% discount when you and a second household 1 member are enrolled in a WPS Medicare supplement plan. To calculate, multiply your final rate by Guaranteed renewable for life. We promise that your WPS Medicare supplement policy will never be canceled because of your health. As long as you pay your premium on time, your WPS Medicare supplement is guaranteed renewable for life. No paperwork. No worries! With our automatic claims service, you don t have to worry about filing claims or dealing with medical bills. That s because Medicare sends your claims electronically right to WPS. We handle the claims and you enjoy the convenience of no paperwork. Online resources just point and click to find what you need. Visit the WPS website at to quickly and easily verify your benefits, eligibility, and claims status. You can request a replacement WPS ID card and Member Guide. You ll also find information in our online health center about healthy eating, managing chronic conditions, patient safety, and more, including a special area devoted to senior health issues. Going the extra mile for members. When you call WPS, you reach people who care. Your questions are answered promptly and accurately by highly trained Member Services representatives supported by state-of-the-art technology. You can be sure our representatives will go the extra mile to assist you. Maybe that s why outstanding member service has been our hallmark for more than 65 years. 1 Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex. The rates in this brochure reflect a discount for using Automated Clearing House, debit card, credit card, automated bank draft, or annual billing by mail. Rates will be $5.00 higher per billing period for members who select direct billing on a monthly, quarterly, or semiannual basis. 23

24 2015 Wisconsin Physicians Service Insurance Corporation. Underwritten by The EPIC Life Insurance Company. All rights reserved

Part B. Coinsurance. Skilled Nursing Facility. 50% Skilled Nursing Facility. Coinsurance. Coinsurance 75% Part A Deductible.

Part B. Coinsurance. Skilled Nursing Facility. 50% Skilled Nursing Facility. Coinsurance. Coinsurance 75% Part A Deductible. AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

Happiness is... Protection from unexpected health care costs.

Happiness is... Protection from unexpected health care costs. Happiness is... Protection from unexpected health care costs. WPS Companion Help Fill the Gaps in with Wisconsin s Most Popular Supplement Plans Lower-premium cost-sharing options available! Effective

More information

Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015

Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015 Outline of Medicare Supplement Coverage Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015 This chart shows the benefits included in each of the standard Medicare Supplement plans.

More information

Skilled Nursing Facility Coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part A Deductible Part B.

Skilled Nursing Facility Coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part A Deductible Part B. Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010

More information

OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G

OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G These charts show the benefits included in each of the standard

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, AND G This chart shows the benefits included in each of the standard Medicare

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, AND G This chart shows the benefits included in each of the standard Medicare

More information

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Basic, including 100% Part B coinsurance. 100% Part B coinsurance

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Basic, including 100% Part B coinsurance. 100% Part B coinsurance Health First Insurance, Inc. OUTLINE OF COVERAGE 2014 Benefit Plans A, F, N Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 This chart shows the benefits included in each of the

More information

A B C D F F* G K L M N Basic,

A B C D F F* G K L M N Basic, Outline of Medicare Supplement Coverage Benefit Plans A, D, and F Corporate Office Omaha, NE Administrative Services PO Box 10386 Des Moines, IA 50306 www.gomedico.com Toll-Free 1-800-228-6080 This chart

More information

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, C, L and N

More information

Plan F* Plan G. Basic, including 100% Basic, including 100% Basic, including 100% Part B coinsurance. Skilled nursing facility coinsurance

Plan F* Plan G. Basic, including 100% Basic, including 100% Basic, including 100% Part B coinsurance. Skilled nursing facility coinsurance Outline of Coverage UnitedHealthcare Insurance Company Overview of Available s Benefit Chart of Medicare Supplement s Sold on or After June 1, 2010 This chart shows the benefits included in each of the

More information

Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance

Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Group Health Options, Inc. Outline of Medicare Supplement Coverage - Cover Page Benefit Plans A, F, K and N See Outlines of Coverage sections for details about ALL plans These charts show the benefits

More information

AFLAC MEDICARE SUPPLEMENT

AFLAC MEDICARE SUPPLEMENT AFLAC MEDICARE SUPPLEMENT P E N N S Y LVA N I A 2 0 13 IC(1/13) AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS Outline of Medicare Supplement Coverage Benefit Plans A, B, C, D, F, G and N Benefit

More information

Texas Department of Insurance

Texas Department of Insurance Texas Department of Insurance Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement

More information

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement plans. Every company must make

More information

AFLAC MEDICARE SUPPLEMENT

AFLAC MEDICARE SUPPLEMENT AFLAC MEDICARE SUPPLEMENT You lead a strong, active, healthy life Make sure a gap in your Medicare coverage doesn t slow you down. GEORGIA 2013 A19MS75GA RC(7/13) Aflac Medicare Supplement Insurance Policy

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

Omaha Insurance Company Application Packet

Omaha Insurance Company Application Packet Omaha Insurance Company Application Packet Thank you for your interest in the Omaha Insurance Company Medicare Supplement plan! This application packet provides you with a link to the Online Application

More information

MedicareBlue Supplement

MedicareBlue Supplement SM MedicareBlue Supplement Plans A, D, F, High Deductible F, and N 2015 Outlines of Coverage Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or after January 1, 2015 This chart shows

More information

UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company

UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE S UPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F AND G These charts show the benefits included in each of the standard

More information

2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com

2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com 2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com MEMBERS HEALTH INSURANCE COMPANY Home Office: P.O. Box 1424, Columbia, TN 38402-1424 1-888-708-0123;

More information

MedicareBlue Supplement SM

MedicareBlue Supplement SM MedicareBlue Supplement SM Important Information about the enclosed premiums and Medicare deductibles and cost-sharing amounts The MedicareBlue Supplement information enclosed in this Outline of Coverage

More information

MEDICARE SUPPLEMENT OUTLINE OF BENEFIT COVERAGE

MEDICARE SUPPLEMENT OUTLINE OF BENEFIT COVERAGE Shaded Sections show Benefit Plans A, B, C, F, High Deductible F*, M and N which are available These charts show the benefits included in each of the standard Medicare Supplement plans. Every company must

More information

Basic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible

Basic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible United of Omaha Life Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, HIGH DEDUCTIBLE F, G, M AND N This chart shows the benefits included

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, G, AND M These charts show the benefits included in each of

More information

2012 STANDARD Medicare Supplement/ Life Insurance Plans

2012 STANDARD Medicare Supplement/ Life Insurance Plans 2012 STANDARD Medicare Supplement/ Life Insurance Plans Issued by Forethought Life Insurance Company ILLINOIS MS3000-01 IL 0112 2012 Forethought Standard Medicare Supplement Insurance Plans You can rely

More information

MEDICARE SUPPLEMENT COVERAGE PENNSYLVANIA

MEDICARE SUPPLEMENT COVERAGE PENNSYLVANIA MEDICARE SUPPLEMENT COVERAGE PENNSYLVANIA The Insurance Plans of Choice for Medicare Supplemental Coverage Philadelphia American Life Insurance Company P.O. BOX 4884 Houston, TX 77210-4884 Plan Form Standard

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N Anthem Blue Cross and Blue Shield Virginia Administrative Office: P.O. Box 27401, Richmond, VA 23279-7401 Toll Free Telephone Number: 1-800-916-2583 Benefit Chart of Medicare Supplement Plans Sold for

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

Offered by. Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010

Offered by. Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 SecureBlue This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make available Plans A, B and C or F. Some plans may not be available in your state.

More information

Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014

Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014 Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014 This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make available Plans

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L

Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L Medicare Supplement insurance can be sold in only 12 standard plans plus two high-deductible

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, B, D and F

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, B, D and F

More information

A B C D F F* G K L M N Basic, Co-insurance. Skilled Nursing Facility Co-insurance 50% Part A. Skilled Nursing Facility. Part A Deductible Part B

A B C D F F* G K L M N Basic, Co-insurance. Skilled Nursing Facility Co-insurance 50% Part A. Skilled Nursing Facility. Part A Deductible Part B TRANSAMERICA PREMIER LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N SEE OUTLINES OF COVERAGE SECTIONS FOR DETAILS ABOUT ALL PLANS These charts show

More information

Health plans for every body

Health plans for every body Health plans for every body Supplemental coverage for Medicare members Medicare modahealth.com/medicare Available April 1 through Dec. 31, 2015 Hello. Welcome to Moda Health, the place you go when you

More information

Basic, including 100% Part B coinsurance* Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible

Basic, including 100% Part B coinsurance* Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible (Agency Note: Proposed new N.J.A.C. 11:4-23 Appendix Exhibit D reproduced below is not depicted in boldface, as would be the standard format for proposed new text, in order for the permanent boldfacing

More information

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible. 50% Skilled Nursing Facility

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible. 50% Skilled Nursing Facility Outline of Medicare Supplement Coverage Standard Benefit for Plan A, Plan F, High Plan F*, Plan N, and Blue Plan65 Select SM Benefit for Plan F and Plan N This chart shows the benefits included in each

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE

MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE This page was intentionally left blank. BENEFIT CHART OF MEDICARE SUPPLEMENT PLANS SOLD FOR EFFECTIVE DATES ON OR AFTER JUNE 1, 2010

More information

Stonebridge Coverage Outline

Stonebridge Coverage Outline Stonebridge Coverage Outline Thank you for your interest in applying for the Stonebridge Life Medicare Supplement plan! Attached is a copy of the policy Outline of Coverage and we have supplied you with

More information

Regence Bridge. Medicare Supplement (Medigap) Plans

Regence Bridge. Medicare Supplement (Medigap) Plans DECISION GUIDE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueCross BlueShield of Utah is an Independent Licensee of the Blue Cross and Blue Shield Association 09708rep07356-ut UT Learn

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Cover page 1 of 2 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 Plans A, B, C, D, F, high deductible F, G, L, M This

More information

Regence Bridge. Medicare Supplement (Medigap) Plans

Regence Bridge. Medicare Supplement (Medigap) Plans OUTLINE OF COVERAGE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association 07355rep06630-or OR

More information

Basic, including 100% Part B. Part B co- Skilled Nursing Facility Coinsurance. Skilled Nursing. Skilled Nursing Facility Coinsurance

Basic, including 100% Part B. Part B co- Skilled Nursing Facility Coinsurance. Skilled Nursing. Skilled Nursing Facility Coinsurance UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G, and M These charts show the benefits included in each of the

More information

UNITED AMERICAN INSURANCE COMPANY

UNITED AMERICAN INSURANCE COMPANY UNITED AMERICAN INSURANCE COMPANY A Nebraska Stock Company Administrative Offices: McKinney, Texas Outline of Medicare Supplement Coverage - Cover Page: 1 of 2 Benefit Plans B, HDF These charts show the

More information

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. GERBER LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans. Every

More information

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F Medicare supplement insurance can be sold in only 10 standard plans plus two high deductible

More information

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance Equitable Life & Casualty Insurance Company Outline Of Medicare Supplement Plans Sold for Effective Date on or After June 1, 2010 These charts show the benefits included in each of the standard Medicare

More information

Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsuranc e Part A Deductible Part B

Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsuranc e Part A Deductible Part B Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must

More information

K L M N Basic, including Basic,

K L M N Basic, including Basic, Companion Life Insurance Company Administrative Office PO Box 14158 Clearwater, Florida 33766-4158 (888) 220-0466 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F and G - See Outlines

More information

APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS

APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS HEARTLAND NATIONAL LIFE INSURANCE COMPANY Medicare Supplement Administrative Office: PO Box 2878, Salt Lake City, UT 84110-2878 APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS HNAPP2013IL (2014)

More information

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2015

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2015 Simply BLUE MEDICARE SUPPLEMENT PLANS 2015 SR BRO 2015 Simply BLUE Table of Contents Standard Benefit Offerings...2 Disclosures...3 Important Facts to Consider...4 Supplement Plan Premiums...5 Benefit

More information

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance Equitable Life & Casualty Insurance Company Outline Of Medicare Supplement Plans Sold for Effective Date on or After June 1, 2010 These charts show the benefits included in each of the standard Medicare

More information

Benefit Plans A, B, F, G and N are Offered

Benefit Plans A, B, F, G and N are Offered Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered This chart show the benefits included in each of the standard Medicare supplement plans with

More information

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2013.1.A

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2013.1.A Simply BLUE MEDICARE SUPPLEMENT PLANS 2013 SR BRO 2013.1.A Simply BLUE Table of Contents Standard Benefit Offerings... 2 Disclosures... 3 Important Facts to Consider... 4 Supplement Plan Premiums... 5

More information

Basic, including 100% 50% Skilled Nursing Facility. Skilled Nursing. Part A Deductible. Part A Deductible. Part B Excess (100%) Foreign Travel

Basic, including 100% 50% Skilled Nursing Facility. Skilled Nursing. Part A Deductible. Part A Deductible. Part B Excess (100%) Foreign Travel UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE STANDARDIZED BENEFIT PLAN A AND SELECT BENEFIT PLANS F AND G Benefit Chart of Medicare

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED OF OMAHA LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G, AND M These charts show the benefits included in each of the standard Medicare supplement

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Benefit Plans A, C, F, L, N for 2016 Outline of Medicare Supplement Coverage Benefit Plans A, C, F, L, N for 2016 These charts show the benefits included in each

More information

Aetna Life Insurance Company Outline of Medicare Supplement Coverage

Aetna Life Insurance Company Outline of Medicare Supplement Coverage Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

MedicareBlue SupplementSM

MedicareBlue SupplementSM MedicareBlue Supplement SM MedicareBlue SupplementSM Choose from five Medicare Supplement Plans M-50374 10/12 M-50374 10/14 2015 enrollment kit I need a Medicare supplement plan I can depend on. Get reliable,

More information

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE OUTLINE OF MEDICARE SUPPLEMENT COVERAGE Tufts Medicare Preferred Supplement Core Tufts Medicare Preferred Supplement One Outline of Medicare Supplement Coverage Cover Page: Benefit Plans Medicare Supplement

More information

How To Get A Medicare Supplement Plan From Aetna Insurance Company

How To Get A Medicare Supplement Plan From Aetna Insurance Company Aetna Individual Medicare Supplement PlanSM Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B and F OOC-MD 18.02.312.1 MD (8/04) Outline of Medicare Supplement Coverage

More information

Skilled Nursing Facility Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible

Skilled Nursing Facility Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE

More information

Regence Bridge. Medicare Supplement (Medigap) Plans

Regence Bridge. Medicare Supplement (Medigap) Plans DECISION GUIDE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Cover Page 1 of 2 ATTAINED AGE BENEFIT PLANS A, C, F, J These charts show the benefits included in each of the 1990 standardized Medicare Supplement plans. Every

More information

Moda Health Coverage Outline

Moda Health Coverage Outline Moda Health Coverage Outline Thank you for your interest in the Moda Health Senior Select Medicare Supplement plan! Attached is a copy of the policy Outline of Coverage and we have supplied you with a

More information

Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015

Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015 19 North Main Street, Wilkes-Barre, Pennsylvania, 18711 Blue Cross of Northeastern Pennsylvania Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015 BlueCare Security Benefit Plans

More information

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% 50% Skilled Nursing Facility. coinsurance.

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% 50% Skilled Nursing Facility. coinsurance. Sentinel Security Life Insurance Company Administrative Office P.O. Box 16960, Clearwater, FL 33766-6960 (888) 510-0668 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, B, C #, D #,

More information

2015 Standard Medicare Supplement Insurance Plans

2015 Standard Medicare Supplement Insurance Plans 2015 Standard Medicare Supplement Insurance Plans Product Overview 77345_TX 0515 2015 MEDICARE SUPPLEMENT INSURANCE PLANS Like all Medicare Supplement insurance plans, Transamerica Premier Life Insurance

More information

Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Part B. Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Coinsurance Part A

Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Part B. Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Coinsurance Part A Guarantee Trust Life Insurance Company Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan(s) A, D, G These charts show the benefits included in each of the standard Medicare supplement

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as HealthNow New York Inc. Medicare Supplement (Medigap) plans. The Medicare Supplement

More information

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. Skilled Nursing Facility Coinsurance Part A Deductible Part B

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. Skilled Nursing Facility Coinsurance Part A Deductible Part B This chart shows the benefits included in each of the standard Medicare supplement plans sold for effective dates on or after June 1, 2010. Every company must make Plan A available. Blue Cross and Blue

More information

OUTLINE OF COVERAGE. Regence Bridge. Medicare Supplement (Medigap) Plans

OUTLINE OF COVERAGE. Regence Bridge. Medicare Supplement (Medigap) Plans OUTLINE OF COVERAGE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueCross BlueShield of Utah is an Independent Licensee of the Blue Cross and Blue Shield Association 09713rep07355-ut UT

More information

HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110

HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110 HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110 Benefit Chart of Medicare Supplement Plans Sold for Effective

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, G, M AND N These charts show the benefits included in each

More information

2015 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N

2015 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N nthem Blue Cross and Blue Shield Connecticut dministrative Office: 370 Bassett Road, North Haven, CT 06473 Toll Free Telephone Number: 1-800-238-1143 2015 Outline of Medicare Supplement Coverage Cover

More information

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. 50% Skilled Nursing Facility. Part B. Deductible. Part B Excess (100%)

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. 50% Skilled Nursing Facility. Part B. Deductible. Part B Excess (100%) This chart shows the benefits included in each of the standard Medicare supplement plans sold for effective dates on or after June 1, 2010. Every company must make Plan A available. Blue Cross and Blue

More information

GERBER LIFE INSURANCE COMPANY WHITE PLAINS, NEW YORK OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE

GERBER LIFE INSURANCE COMPANY WHITE PLAINS, NEW YORK OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE GERBER LIFE INSURANCE COMPANY WHITE PLAINS, NEW YORK OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BASIC AND EXTENDED BASIC PLANS The Commissioner of Insurance of the State of Minnesota has established

More information

Outline of Coverage. Medicare Supplement

Outline of Coverage. Medicare Supplement Outline of Coverage Medicare Supplement 2015 Security Health Plan of Wisconsin, Inc. Medicare Supplement Outline of Coverage Medicare Supplement policy The Wisconsin Insurance Commissioner has set standards

More information

A B C D F l F* G K L M N Basic including

A B C D F l F* G K L M N Basic including Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, C, F, G and N are Offered This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible Part B. 50% Skilled Nursing Facility

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible Part B. 50% Skilled Nursing Facility Outline of Medicare Supplement Coverage Standard Benefit for Plan A, Plan F, High Plan F*, Plan N, and Blue Plan65 Select Benefit for Plan F and Plan N This chart shows the benefits included in each of

More information

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT STANDARD PLANS A, B, C, D, F, J AND HIGH DEDUCTIBLE PLAN F

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT STANDARD PLANS A, B, C, D, F, J AND HIGH DEDUCTIBLE PLAN F Anthem Blue Cross Blue Shield Connecticut Administrative Office: PO Box 1014 North Haven, CT 06473 Toll Free Telephone Number: 1-800-238-1143 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT

More information

Outline of Medicare Supplement Coverage TUFTS MEDICARE PREFERRED SUPPLEMENT PLANS 2015

Outline of Medicare Supplement Coverage TUFTS MEDICARE PREFERRED SUPPLEMENT PLANS 2015 TUFTS MEDICARE PREFERRED SUPPLEMENT PLANS 2015 Outline of Medicare Supplement Coverage Tufts Medicare Preferred Supplement Core Tufts Medicare Preferred Supplement One Effective January 1, 2015 December

More information

A B C D F F* G K L M N Basic,

A B C D F F* G K L M N Basic, 1515 South 75th Street Omaha, Nebraska 68124 Outline of Medicare Supplement Coverage Benefit Plans A, D, and F www.gomedico.com Toll-Free 1-800-228-6080 This chart shows the benefits included in each of

More information

2016 Guide to Understanding Your Benefits

2016 Guide to Understanding Your Benefits 2016 Guide to Understanding Your Benefits Additional information about covered benefits available from Health Net Healthy Heart (HMO) Plan Alameda, Stanislaus counties, CA Lisa Pasillas-Le, Health Net

More information

Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N

Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N This chart shows the benefits included in each of the standard Medicare supplement

More information

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered Incorporated Document (6) [COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered These charts show the benefits included in each

More information

HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110

HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110 HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110 Benefit Chart of Medicare Supplement Plans Sold for Effective

More information

Medicare Select plans offer freedom, convenience and affordability. Medicare Select Plans. For Kentucky residents. PKY-91 Rev.

Medicare Select plans offer freedom, convenience and affordability. Medicare Select Plans. For Kentucky residents. PKY-91 Rev. Medicare Select plans offer freedom, convenience and affordability. Medicare Select Plans For Kentucky residents PKY-91 Rev. 7/05 Medicare Select Plans Anthem s Select Hospital Network makes these supplement

More information

Plan F & Plan F* Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible. Part B Excess (100%) Foreign Travel Emergency

Plan F & Plan F* Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible. Part B Excess (100%) Foreign Travel Emergency Outline of Medicare Supplement Coverage By Reason of Age Cover Page: Benefit Plans A, F, High F and N See Outlines of Coverage sections for detail about all plans. This chart shows the benefits included

More information

100% of Medicare-eligible expenses Beyond the additional 365 $0 $0 $0 $0

100% of Medicare-eligible expenses Beyond the additional 365 $0 $0 $0 $0 Medicare Supplement Policy Comparison Chart Effective January 1, 2015 Medicare Supplement or BlueCare Plans A, B and C Part A Hospital Insurance Covered Services SERVICE MEDICARE PAYS PLAN A PAYS PLAN

More information

A B C D F F* G K L M N Basic, including. Basic, including. coinsurance. 75% Skilled Nursing. Facility Coinsurance. 50% Part A. Deductible.

A B C D F F* G K L M N Basic, including. Basic, including. coinsurance. 75% Skilled Nursing. Facility Coinsurance. 50% Part A. Deductible. This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. AmeriHealth Insurance

More information

Basic Benefits Skilled Nursing Facility Coinsurance Part A Deductible

Basic Benefits Skilled Nursing Facility Coinsurance Part A Deductible MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 STANDARDIZED BENEFIT PLAN A AND SELECT BENEFIT PLANS B, C, D, E, F AND G These charts show the benefits included

More information