Secure Plan (HMO) January 1, 2015 December 31, 2015 SECTION I INTRODUCTION. You have choices about how to get your Medicare benefits

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Secure Plan (HMO) January 1, 2015 December 31, 2015 SECTION I INTRODUCTION. You have choices about how to get your Medicare benefits"

Transcription

1 Secure Plan (HMO) January 1, 2015 December 31, 2015 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 every limitation or exclusion. To get a complete list of services we cover, call us and ask for the Evidence of Coverage. You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (feefor-service Medicare). Original Medicare is run directly by the Federal government. Another choice is to get your Medicare benefits by joining a Medicare health plan such as Health First s Secure Plan (HMO). Tips for comparing your Medicare choices This Summary of Benefits booklet gives you a summary of what Health First s Secure Plan (HMO) covers and what you pay. If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits booklets. Or, use the Medicare Plan Finder on If you want to know more about the coverage and costs of Original Medicare, look in your current Medicare & You handbook. View it online at or get a copy by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call Sections in this booklet Things to Know About Health First s Secure Plan (HMO) Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services Covered Medical and Hospital Benefits This document is available in other formats such as Braille and large print. This document may be available in a non- English language. For additional information, call us at (TDD/TTY relay: ). Y0089_EL4308 Accepted Page 1 of 13

2 Things to Know About Health First s Secure Plan (HMO) Hours of Operation From October 1 to February 14, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Eastern time. From February 15 to September 30, you can call us Monday from 8:00 a.m. to 8:00 p.m. Eastern time, Tuesday from 8:00 a.m. to 8:00 p.m. Eastern time, Wednesday from 8:00 a.m. to 8:00 p.m. Eastern time, Thursday from 8:00 a.m. to 8:00 p.m. Eastern time, Friday from 8:00 a.m. to 8:00 p.m. Eastern time, Saturday from 8:00 a.m. to 12:00 p.m. Eastern time. Health First s Secure Plan (HMO) Phone Numbers and Website If you are a member of this plan, call tollfree (TDD/TTY relay: ). If you are not a member of this plan, call toll-free (TDD/TTY relay: ). Our website: Who can join? To join Health First s Secure Plan (HMO), you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area includes the following counties in Florida: Brevard and Indian River. Which doctors, hospitals, and pharmacies can I use? Health First s Secure Plan (HMO) has a network of doctors, hospitals, pharmacies, and other providers. For some services you can use providers that are not in our network. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs. You can see our plan's provider and pharmacy directory at our website, Or, call us and we will send you a copy of the provider and pharmacy directories. What do we cover? Like all Medicare health plans, we cover everything that Original Medicare covers and more. Our plan members get all of the benefits covered by Original Medicare. For some of these benefits, you may pay more in our plan than you would in Original Medicare. For others, you may pay less. Our plan members also get more than what is covered by Original Medicare. Some of the extra benefits are outlined in this booklet. Health First s Secure Plan (HMO) covers Part B drugs including chemotherapy and some drugs administered by your provider. However, this plan does not cover Part D drugs. Y0089_EL4308 Accepted Page 2 of 13

3 SUMMARY OF BENEFITS January 1, 2015 December 31, 2015 Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services How much is the monthly premium? How much is the deductible? Is there any limit on how much I will pay for my covered services? Is there a limit on how much the plan will pay? $0 per month. In addition, you must keep paying your Medicare Part B premium. This plan does not have a deductible. Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. Your yearly limit(s) in this plan: $3,400 for services you receive from in-network providers. If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums. Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply. Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. Covered Medical and Hospital Benefits Note: Services with a 1 may require prior authorization. Services with a 2 may require a referral from your doctor. OUTPATIENT CARE AND SERVICES Acupuncture and Other Alternative Therapies Not covered Ambulance 1 $175 copay Chiropractic Care Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay Y0089_EL4308 Accepted Page 3 of 13

4 Dental Services Diabetes Supplies and Services 1 Diagnostic Tests, Lab and Radiology Services, and X- Rays 1 Doctor s Office Visits Durable Medical Equipment (wheelchairs, oxygen, etc.) 1 Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth): You pay nothing Preventive dental services: Cleaning: You pay nothing. Dental x-ray(s): You pay nothing. Oral exam: You pay nothing. Our plan pays up to $100 every year for preventive dental services. Diabetes monitoring supplies: 20% of the cost Diabetes self-management training: You pay nothing Therapeutic shoes or inserts: 20% of the cost Diagnostic radiology services (such as MRIs, CT scans): $150 copay Diagnostic tests and procedures: You pay nothing Lab services: You pay nothing Outpatient X-rays: You pay nothing Therapeutic radiology services (such as radiation treatment for cancer): You pay nothing Primary care physician visit: $10 copay Specialist visit: $25 copay 20% of the cost Y0089_EL4308 Accepted Page 4 of 13

5 Emergency Care Foot Care (podiatry services) $50 copay If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for emergency care. See the Inpatient Hospital Care section of this booklet for other costs. Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $25 copay Hearing Services Home Health Care 1 Mental Health Care 1 Exam to diagnose and treat hearing and balance issues: $15 copay Routine hearing exam (for up to 1 every year): $15 copay Hearing aid: You pay nothing Our plan pays up to $250 every year for hearing aids. You pay nothing Inpatient visit: Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital. Our plan covers 90 days for an inpatient stay. Our plan also covers 60 lifetime reserve days. These are extra days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days. $175 copay per day for days 1 through 10 You pay nothing per day for days 11 through 90 Outpatient group therapy visit: $25 copay Outpatient individual therapy visit: $25 copay Outpatient Rehabilitation 1 Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions Y0089_EL4308 Accepted Page 5 of 13

6 Outpatient Substance Abuse 1 Outpatient Surgery 1 Over-the-Counter Items Prosthetic Devices (braces, artificial limbs, etc.) 1 Renal Dialysis Transportation Urgent Care Vision Services per day for up to 36 sessions up to 36 weeks): $25 copay Occupational therapy visit: $25 copay Physical therapy and speech and language therapy visit: $25 copay Group therapy visit: $25 copay Individual therapy visit: $25 copay Ambulatory surgical center: $150 copay Outpatient hospital: $150 copay Not Covered Prosthetic devices: 20% of the cost Related medical supplies: 20% of the cost 20% of the cost Not covered $30 copay Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-15 copay, depending on the service Routine eye exam (for up to 1 every year): You pay nothing Eyeglasses (frames and lenses): You pay nothing Eyeglasses or contact lenses after cataract surgery: You pay nothing Y0089_EL4308 Accepted Page 6 of 13

7 Our plan pays up to $100 every year for eyeglasses (frames and lenses). PREVENTIVE CARE Preventive Care HOSPICE Hospice You pay nothing Our plan covers many preventive services, including: Abdominal aortic aneurysm screening Alcohol misuse counseling Bone mass measurement Breast cancer screening (mammogram) Cardiovascular disease (behavioral therapy) Cardiovascular screenings Cervical and vaginal cancer screening Colonoscopy Colorectal cancer screenings Depression screening Diabetes screenings Fecal occult blood test Flexible sigmoidoscopy HIV screening Medical nutrition therapy services Obesity screening and counseling Prostate cancer screenings (PSA) Sexually transmitted infections screening and counseling Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots Welcome to Medicare preventive visit (one-time) Yearly "Wellness" visit Any additional preventive services approved by Medicare during the contract year will be covered. You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care. Y0089_EL4308 Accepted Page 7 of 13

8 INPATIENT CARE Inpatient Hospital Care 1 Inpatient Mental Health Care Skilled Nursing Facility (SNF) 1 Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 lifetime reserve days. These are extra days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days. $200 copay per day for days 1 through 10 You pay nothing per day for days 11 through 90 For inpatient mental health care, see the "Mental Health Care" section of this booklet. Our plan covers up to 100 days in a SNF. You pay nothing per day for days 1 though 20 $50 copay per day for days 21 though 100 Prescription Drug Benefits How much do I pay? For Part B drugs such as chemotherapy drugs 1 : 20% of the cost Other Part B drugs 1 : 20% of the cost Our plan does not cover Part D prescription drugs. Y0089_EL4308 Accepted Page 8 of 13

9 Obtaining Covered Medical Care How do I get medical and behavioral health care? The way you obtain routine medical care will depend on the type of plan you have. General provisions HMO Plans: Generally speaking, HMO plans require you to see participating providers for covered services, except for urgent care, emergency care and dialysis outside the service area. All other out-of-network services must be authorized in advance by Health First Health Plans (HFHP) or they will not be covered. It is important to remember this provision, especially when you are outside our service area for any reason. If you are enrolled in an HMO plan, it is very important that you know whether or not your provider participates with HFHP so you don t incur charges for services that may not be covered. Be sure to check your Summary of Benefits, Evidence of Coverage, visit our website or contact us to determine if services are covered. HMO-POS Plans: You may see non-participating providers but your costs may be higher than if you receive the services innetwork from participating providers. These types of plans offer more choices in the delivery of health care, but typically include higher premiums and out-of-pocket costs. Be sure to check your Summary of Benefits, Evidence of Coverage, visit our website or contact us to determine if services are covered. Regardless of which general type of plan you have, benefits and cost-sharing requirements will vary depending on the plan you re enrolled in. Primary care To access primary care, simply contact your doctor to make an appointment. For after-hours care, you can also call your doctor s answering service 24 hours a day for instructions. You may be directed to an urgent care center or to make an appointment when your physician s office is open. You may also be directed to an emergency room, if you think you have a medical emergency. Emergency care If you have a medical emergency, have someone take you to the closest emergency room. If you cannot get to the emergency room safely and quickly, call 911. Be sure to show your HFHP member ID card. If you are admitted to the hospital or need help coordinating your care after you are stabilized, have someone contact HFHP and your local doctor for assistance. We cover emergency medical care anywhere in the world and will help arrange for your transfer home if necessary. Urgently-needed care If you need care after hours or urgently, but it is not an emergency, participating urgent care centers are open evenings and weekends. They are listed in your Provider Directory and on our website. Avoiding unnecessary trips to a hospital emergency room can save you time and money. You may also contact Nurse24 at if you have a question that you would like answered by a health care professional. This toll-free line is available 24 hours per day, 7 days per week. If you are outside the service area, you are covered for unforeseen illnesses or injuries that need to be treated before you return. Simply locate an urgent care clinic or other physician for the initial treatment and contact your local doctor to obtain any necessary follow-up services. If at all possible, try to locate a provider that is part of our contracted national provider network, as we have negotiated preferred pricing through this network for out-of-area care. You can locate one of these providers by contacting us for assistance. Y0089_EL4308 Accepted Page 9 of 13

10 Hospital care If you need to be hospitalized and it s not an emergency, your doctor must get authorization from us first and coordinate your admission. Authorizations may be required for some outpatient services performed at a hospital, but if you see a participating doctor, he or she will know if that s necessary and can take care of it for you. You never need authorization for emergency care at any hospital. If you are admitted to a non-participating hospital as part of your emergency care, please have someone contact us at so we can help coordinate your care as soon as possible. Mental (behavioral) health services Mental health services can be accessed directly without a physician referral as with other specialty care. If you are enrolled in an HMO plan, you can arrange for the appropriate services by calling Magellan Health Services directly at HFHP (4347); TTY/TDD users should call or visiting their website at A mental health professional will assist you with obtaining the help you need. HMO-POS members can access the provider of their choice and applicable cost-sharing amounts will apply. When do I need a referral or authorization? To make it easy for you to obtain medical care, HFHP does not require members to get a referral to see participating specialists for covered services. However, some specialists may require you to be referred by your primary doctor to ensure your care is coordinated properly. To locate a participating provider for specialty care, please see your Provider Directory or contact us for assistance. While most covered medical care can be obtained without our involvement, some services require prior authorization by our Medical Management staff to ensure the right care is provided in the right setting. Your physician will assist you by contacting us for services that require prior authorization. Also, remember that referrals and prior-authorized services are still subject to plan exclusions and limitations. Check our current Authorization List to see if approval is required in advance and to ensure you don t incur any unexpected expenses for services that may not be covered. You can get the Authorization List from our website or by calling us. Certain services require prior authorization to be covered and POS members obtaining care from non-participating providers are responsible to ensure authorization is obtained. A few examples that require prior authorization include MRI, PET, CT scans and nuclear cardiology studies, but other services require authorization and the list is subject to change. If you are using a provider who does not participate in the Health First Health Plans network, including our contracted national provider network, please be sure you discuss the authorization process with your provider, notify HFHP and make sure the service is approved before receiving it. You are responsible for notifying your non-participating physician that authorization is required for these procedures. If your physician has any questions or needs instructions on how to obtain prior authorization, he or she may contact our Customer Service department for additional information. What if I need a second opinion? For HMO and POS members, a second medical opinion related to the need for surgery or a major non-surgical diagnosis/therapeutic procedure with a HFHP participating provider does not require prior authorization. In network office cost share would apply. For HMO members, a second opinion with an out of network provider requires prior authorization. Please contact Health First Health Plans to submit a prior authorization request. For POS members, the out of network office cost share will apply if prior authorization is not obtained prior to seeing an out of network provider. All third opinions require prior authorization. Health Y0089_EL4308 Accepted Page 10 of 13

11 First Health Plans has a limit of three opinions per medical condition per calendar year. Decision making at HFHP HFHP assures providers, practitioners and members that all decisions involving HFHP coverage are based on the appropriateness of care and service. We do not compensate practitioners or any other individuals for making decisions that could result in denials of care. Denials are based on medical necessity or contract provisions. HFHP works to prevent inappropriate decision making by regularly monitoring all medical claims and request for care. We are committed to providing you access to quality care. Health management When it comes to your health, sometimes you need more information and a little support making a decision. Sometimes you just need someone to talk to one-on-one about how to live a healthier life in body and mind. Health First Health Plans is committed to providing members a complete managed care network which delivers the highest quality, most cost effective care possible. The Health Plan looks at the inpatient and ambulatory care (including: pre-service, concurrent, or post-service authorization) using utilization review criteria to make sure this is appropriate and timely. Health First Health Plans considers multiple factors when making coverage decisions, including member benefit contracts, laws and regulations, and the medical necessity of a requested item or service regarding the member s unique clinical situation. The Health Plan involves appropriate professionals in the development, adoption, and review of criteria and medical coverage policies. When available, Medical Policies will be used to make medical necessity decisions. If there is no Medical Policy, the following evidence-based resources will be applied by appropriate reviewers: Centers for Medicare & Medicaid Services (CMS), Milliman Care Guidelines, Hayes Technology Assessments, Peer-reviewed published medical literature, Clinical guidelines from nationally recognized authorities and FDA approval status (approval does not imply medical necessity). The Health Plan uses the approved new medical technologies or new uses of existing technologies after a complete review of the literature and recommendations from our specialists. Health First Health Plans measures and reviews professional and member satisfaction with Utilization Management services and takes action on identified opportunities for improvement. Health Coaches When it comes to your health, sometimes you need more information and a little support making a decision. Sometimes you just need someone to talk to one-on-one about how to live a healthier life in body and mind. HFHP offers access to a personal Health Coach, at no additional cost by phone, or chat 24 hours a day, 7 days a week. A Health Coach is a trained, healthcare professional (a nurse, dietician or respiratory therapist) who can provide you with oneon-one information on a variety of health issues, help you monitor your health needs and help you work more closely with your doctor. Health Coaches can also help you identify incremental goals to sustain long-term behavior changes in the following areas: Improve your diet You can: Feel and look better Manage stress Gain confidence Reach a healthy weight Have more energy Improve your fitness level Talk with a Health Coach anytime, day or night for information about enrolling or if you have any questions. Just call to speak with a knowledgeable and caring healthcare professional. Once you have signed up for the program, you will get a Health Coaching workbook which includes goal setting resources that promote healthy behavior changes. Y0089_EL4308 Accepted Page 11 of 13

12 Receive personalized monthly check-in calls. Also, you can or call your coach any other time. Use online services featuring 24/7 access to health and decision support tools by logging into our website at Other online health management services There are many other health management services you should take advantage of by logging into our website at This information is available 24/7 and is designed to empower you to be more accountable for your own health. Through our Healthy Living program (online module), you can get information about disease conditions and help meeting wellness goals you might have such as smoking cessation. Disease Management/Chronic Care Access your up-to-date health information by logging into our website at You can take the Health Assessment to learn about your own health risks and what you can do to lower them. You can also access in-depth information on more than 1,900 health topics including medical tests and medications. There are also many videos and DVDs available to you, at no charge, on conditions such as breast cancer, prostate cancer, back pain and osteoporosis. Need someone to talk to about a health issue? Call a healthcare professional at for caring support from someone who will take the time to listen to your concerns and answer your questions. They are ready to assist you with general health information, and support on managing a chronic illness such as: Diabetes Heart disease Congestive heart failure Asthma Coronary artery disease COPD Complex case management For our members coping with complex or serious medical conditions, a life-changing accident or experiencing frustration or roadblocks in trying to get the care you feel you need, HFHP offers a personal RN-Case Manager to work one-on-one with you, your family and/or caregivers to help navigate the sometimes confusing world of healthcare. These highly trained and professional nurses work closely with your medical team to make sure you understand your condition, the best treatment options available and how to connect with any support you may need during this challenging time in your life. We have highly skilled social workers available to assist with community resources or financial problem solving as well. Members undergoing transplants, cancer treatments or any other complex medical condition are appropriate for this service. Please contact Customer Service to access our Complex Case Management services. Additional Management Programs Physician Home Visiting Program You may be referred to a Physician Home Visiting Program if you are unable to get to the doctor s office due to illness. If you meet requirements for this program, you have access to a doctor or nurse practitioner 24 hours per day, 7 days per week. These health care professionals may come to your home and are able to provide medical care, many times preventing emergency room visits and admissions to the hospital. These professionals work closely with you and your family or caregivers, doctors and our Health Plans staff to help keep you in the best possible health and teach you how to cope with your illness. Transition Program Some medical conditions are known to cause frequent trips to the hospital. Members who are hospitalized with one of these conditions may qualify for the Transition Program. Care Management reaches out to these members within the first week after discharge from the hospital to see if extra care from a doctor Y0089_EL4308 Accepted Page 12 of 13

13 in the home might help them to understand their medicines, discharge instructions and illness. Some of the illnesses that would qualify someone for this program include, but are not limited to, congestive heart failure, heart disease and diabetes. Y0089_EL4308 Accepted Page 13 of 13

2015 Medicare Advantage Summary of Benefits

2015 Medicare Advantage Summary of Benefits 2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015

More information

[2015] SUMMARY OF BENEFITS H1189_2015SB

[2015] SUMMARY OF BENEFITS H1189_2015SB [2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare

More information

Summary of Benefits Community Advantage (HMO)

Summary of Benefits Community Advantage (HMO) Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 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

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1 January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

HNE Premier 1 (HMO) and HNE Premier 2 (HMO) 2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

More information

Independent Health s Medicare Passport Advantage (PPO)

Independent Health s Medicare Passport Advantage (PPO) Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary

More information

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO) FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015

More information

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we

More information

Summary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO)

Summary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO) Summary of Benefits January 1, 2016 December 31, 2016 FIRSTCAROLINACARE INSURANCE COMPANY FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties This booklet

More information

H9412_14238_8 File and Use 8/31/14

H9412_14238_8 File and Use 8/31/14 Introduction to Summary of s 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). Original Medicare

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) (H4270) January 1, 2015 - December 31, 2015 Western Wisconsin (26 Counties) H4270_082914_1 CMS Accepted (09032014) SECTION I INTRODUCTION

More information

Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711)

Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711) Summary of s and January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website at www.martinspoint.org/medicare. 1-888-408-8285

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits January 1, 2015 December 31, 2015 Houston/Beaumont Area Y0067_PRE_H4506_SETX_SB41_0814 CMS Accepted 09/13/2014 HMO-SETX-SB K41 2015 Section I Introduction to Summary of Benefits

More information

H3954_14238_3 File and Use 8/31/14

H3954_14238_3 File and Use 8/31/14 Introduction to Summary Of s 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). Original Medicare

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of

More information

Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595

Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015 HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 For Medicare-eligible beneficiaries residing in Arenac, Bay,

More information

January 1, 2015 December 31, 2015

January 1, 2015 December 31, 2015 BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)

More information

2015 Summary of Benefits Aultimate Plan (HMO-POS) E00060

2015 Summary of Benefits Aultimate Plan (HMO-POS) E00060 2015 Summary of Benefits Aultimate Plan (HMO-POS) E00060 H3664_E00060SB_15 Accepted 08312014 SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1 January 1, 2016 December 31, 2016 Summary of Benefits H3312-060 H3312.060.1 Y0001_2016_H3312_060 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8713_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with

More information

Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma

Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma Summary of Benefits 2016 HMO King, Pierce, Snohomish, Spokane and Thurston Counties premera.com/ma Plus Section 1 Introduction to the and Plus This booklet gives you a summary of what we cover and what

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8712_2014F File & Use Accepted 09032014 ( a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with a Medicare contract)

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Ruby Select (HMO) Maricopa and Pinal counties Benefits effective January 1, 2015 H0351 Health Net of Arizona, Inc. Material ID # H0351_2015_0258 CMS Accepted 08302014

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Healthy Heart (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0273 CMS Accepted

More information

SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted

SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health

More information

SUMMARY OF BENEFITS CARE1ST HEALTH PLAN. Care1st AdvantageOptimum Plan (HMO) California: Fresno, Merced, Stanislaus and San Joaquin Counties

SUMMARY OF BENEFITS CARE1ST HEALTH PLAN. Care1st AdvantageOptimum Plan (HMO) California: Fresno, Merced, Stanislaus and San Joaquin Counties SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 CARE1ST HEALTH PLAN 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 every

More information

SUMMARY OF BENEFITS 2016 EmblemHealth PPO I and EmblemHealth Advantage (PPO) Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester

SUMMARY OF BENEFITS 2016 EmblemHealth PPO I and EmblemHealth Advantage (PPO) Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester SUMMARY OF BENEFITS 2016 and Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester January 1, 2016 December 31, 2016 H5528_125910 Accepted 9/13/2015 SECTION I - INTRODUCTION TO SUMMARY

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Ruby Select (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0285_B_CMS Accepted

More information

of BenefitS Cigna-HealthSpring Preferred (Hmo) H4513-024 - 2 2014 Cigna H4513_15_19942 Accepted

of BenefitS Cigna-HealthSpring Preferred (Hmo) H4513-024 - 2 2014 Cigna H4513_15_19942 Accepted agesummary of BenefitS Cover erage Cigna-HealthSpring Preferred (Hmo) H4513-024 - 2 2014 Cigna H4513_15_19942 Accepted SeCtion i - introduction to Summary of BenefitS you have choices about how to get

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Ruby (HMO) Benton, Clackamas, Lane, Linn, Marion, Multnomah, Polk, Washington and Yamhill counties, OR Benefits effective January 1, 2015 H6815 Health Net Health Plan

More information

CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO)

CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO) Introduction to the Summary of Benefits Report for CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO) January 1, 2015 December 31, 2015 CAPITAL, CENTRAL, SOUTHERN TIER,

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits January 1, 2015 December 31, 2015 City of Houston Y0067_PRE_COH_SB_1014 IA 11/06/2014 HMO-COH-SB 2015 Section I Introduction to Summary of Benefits You have choices about how to

More information

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Select Plan (HMO) H3623-018 58.06.360.1-OH3 B

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Select Plan (HMO) H3623-018 58.06.360.1-OH3 B January, 205 December 3, 205 Summary of Benefits H3623-08 58.06.360.-OH3 B Y000_205_H3623_08_OH Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Prime Plan (HMO) H3931-087 H3931.087.1

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Prime Plan (HMO) H3931-087 H3931.087.1 January 1, 2016 December 31, 2016 Summary of Benefits H3931-087 H3931.087.1 Y0001_2016_H3931_087 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Healthy Heart (HMO) Alameda and Stanislaus counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0171 CMS Accepted 09172015

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 Care1st AdvantageOptimum Plan (HMO) Texas: El Paso County H5928_15_029_SB_EP INTRODUCTION

More information

Summary of Benefits. Service To Seniors (HMO) and OC Preferred (HMO) It s Personal. Medicare Specialist Scott Pratt Se Habla Español.

Summary of Benefits. Service To Seniors (HMO) and OC Preferred (HMO) It s Personal. Medicare Specialist Scott Pratt Se Habla Español. 2015 Summary of Benefits Service To Seniors (HMO) and OC Preferred (HMO) Medicare Specialist Scott Pratt Se Habla Español. It s Personal. H0545_RAY2012_xxx CMS Approved: xx/xx/2012 H0545_FUY2015_18 Accepted

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Coventry Medicare Advantage Total Care (HMO) H2672-009 H2672.009.1

January 1, 2016 December 31, 2016. Summary of Benefits. Coventry Medicare Advantage Total Care (HMO) H2672-009 H2672.009.1 January 1, 2016 December 31, 2016 Summary of Benefits H2672-009 H2672.009.1 Y0001_2016_H2672_009 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

2016 Summary of Benefits

2016 Summary of Benefits HMO and 2016 Summary of Benefits Western Pennsylvania H3957_15_0265 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay.

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits January 1, 2015 December 31, 2015 Kit 02 Y0067_PRE_H2816_SBK02_0814 CMS Accepted 09/13/2014 NPFFS-SB K02 2015 Section I Introduction to Summary of Benefits You have choices about

More information

Medicare Summary of. Benefits MIAMI-DADE COUNTY

Medicare Summary of. Benefits MIAMI-DADE COUNTY Medicare Summary of MIAMI-DADE COUNTY AVMED MEDICARE CHOICE a Medicare Advantage Health Maintenance Organization (HMO) by AvMed, Inc. with a Medicare contract January 1, 2015 December 31, 2015 MIAMI-DADE

More information

SUMMARY OF BENEFITS. Cigna-HealthSpring Traditions (HMO SNP) H2108-020. January 1, 2016 - December 31, 2016. 2015 Cigna H2108_16_32732 Accepted

SUMMARY OF BENEFITS. Cigna-HealthSpring Traditions (HMO SNP) H2108-020. January 1, 2016 - December 31, 2016. 2015 Cigna H2108_16_32732 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Traditions (HMO SNP) H2108-020 2015 Cigna H2108_16_32732 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet

More information

Blue Shield 65 Plus Choice Plan (HMO) Blue Shield 65 Plus (HMO) summary of benefits

Blue Shield 65 Plus Choice Plan (HMO) Blue Shield 65 Plus (HMO) summary of benefits summary of benefits Los Angeles (partial) & Orange Counties January 1, 2015 to December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we

More information

2016 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS

2016 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS 2016 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS California Santa Clara County H5087 January 1, 2016 - December 31, 2016 Easy Choice Best Plan (HMO) Plan 014 H5087_CA030093_WCM_SOB_ENG CMS Accepted WellCare

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, 2016 December 31, 2016 The provider network may change at any time. You will receive notice when necessary. Call toll-free 1-888-382-9771 8 a.m. to 8 p.m., 7 days a week

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:,, San Bernardino and Counties Coordinated Choice California: Alameda,

More information

2015 Summary of Benefits Western Pennsylvania

2015 Summary of Benefits Western Pennsylvania Security Blue HMO and Community Blue Medicare HMO 2015 Summary of Benefits Western Pennsylvania H3957_14_0229 Accepted SECTION ONE: INTRODUCTION TO SUMMARY OF S Community Blue Medicare Signature (HMO)

More information

SUMMARY OF BENEFITS. Cigna-HealthSpring. Preferred (HMO) H2108-022. January 1, 2016 - December 31, 2016. 2015 Cigna H2108_16_32731 Accepted

SUMMARY OF BENEFITS. Cigna-HealthSpring. Preferred (HMO) H2108-022. January 1, 2016 - December 31, 2016. 2015 Cigna H2108_16_32731 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Preferred (HMO) H2108-022 2015 Cigna H2108_16_32731 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet gives

More information

SUMMARY OF BENEFITS. Cigna-HealthSpring. Preferred (HMO) H9725-001. January 1, 2016 - December 31, 2016. 2015 Cigna H9725_16_32700 Accepted

SUMMARY OF BENEFITS. Cigna-HealthSpring. Preferred (HMO) H9725-001. January 1, 2016 - December 31, 2016. 2015 Cigna H9725_16_32700 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Preferred (HMO) H9725-001 2015 Cigna H9725_16_32700 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet gives

More information

BlueCHiP for Medicare Group Plus (HMO) Summary of Benefits. January 1, 2015 - December 31, 2015

BlueCHiP for Medicare Group Plus (HMO) Summary of Benefits. January 1, 2015 - December 31, 2015 BlueCHiP for Medicare Group Plus (HMO) Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we

More information

Coventry Advantra (HMO) Teachers Retiree Insurance Program January 1, 2015 - December 31, 2015 (a Medicare Advantage Health Maintenance Organization

Coventry Advantra (HMO) Teachers Retiree Insurance Program January 1, 2015 - December 31, 2015 (a Medicare Advantage Health Maintenance Organization Coventry Advantra (HMO) Teachers Retiree Insurance Program January 1, 2015 - December 31, 2015 (a Medicare Advantage Health Maintenance Organization (HMO) offered by Coventry Health Care with a Medicare

More information

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Premier Plan (PPO) H5521-081 58.06.362.1-NC1

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Premier Plan (PPO) H5521-081 58.06.362.1-NC1 January 1, 2015 December 31, 2015 Summary of Benefits H5521-081 58.06.362.1-NC1 Y0001_2015_H5521_081_NC Accepted 9/2014 Summary of Benefits January 1, 2015 December 31, 2015 This booklet gives you a summary

More information

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Premier Plan (PPO) H5521-081 58.06.362.1-NC1

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Premier Plan (PPO) H5521-081 58.06.362.1-NC1 January, 205 December 3, 205 Summary of Benefits H552-08 58.06.362.-NC Y000_205_H552_08_NC Accepted 9/20 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we cover

More information

Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal.

Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal. Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal. Section 1 Introduction to the Summary of Benefits for

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Connect Plus (HMO) H3931-088 H3931.088.1

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Connect Plus (HMO) H3931-088 H3931.088.1 January 1, 2016 December 31, 2016 Summary of Benefits H3931-088 H3931.088.1 Y0001_2016_H3931_088 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3156 Y0041_H3156_AH_15_18888 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

Introduction to Summary of Benefits

Introduction to Summary of Benefits Introduction to Summary of Benefits Section I CENTRAL HEALTH MEDICARE PLAN (HMO), CENTRAL HEALTH MEDI-MEDI PLAN (HMO SNP), CENTRAL HEALTH PREMIER PLAN (HMO), and CENTRAL HEALTH FOCUS PLAN (HMO SNP) (a

More information

SUMMARY OF BENEFITS. Cigna-HealthSpring Achieve (HMO SNP) H3949-024. January 1, 2016 - December 31, 2016. 2015 Cigna H3949_16_32723 Accepted

SUMMARY OF BENEFITS. Cigna-HealthSpring Achieve (HMO SNP) H3949-024. January 1, 2016 - December 31, 2016. 2015 Cigna H3949_16_32723 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Achieve (HMO SNP) H3949-024 2015 Cigna H3949_16_32723 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet gives

More information

Companion Basic Rx (HMO) / Companion Rx (HMO) / Companion Plus Rx (HMO)

Companion Basic Rx (HMO) / Companion Rx (HMO) / Companion Plus Rx (HMO) / / Summary of Benefits January 1, 2016 December 31, 2016 The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. s pharmacy network offers

More information

Section I Introduction To Summary Of Benefits

Section I Introduction To Summary Of Benefits 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

2015 SUMMARY OF BENEFITS Phoenix Advantage (HMO) Phoenix Advantage Select (HMO) January 1, 2015 December 31, 2015. H5985_009-2015 Accepted

2015 SUMMARY OF BENEFITS Phoenix Advantage (HMO) Phoenix Advantage Select (HMO) January 1, 2015 December 31, 2015. H5985_009-2015 Accepted 2015 SUMMARY OF BENEFITS Phoenix Advantage (HMO) Phoenix Advantage Select (HMO) January 1, 2015 December 31, 2015 H5985_009-2015 Accepted SUMMARY OF BENEFITS JANUARY 1, 2015 - DECEMBER 31, 2015 This booklet

More information

Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal.

Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal. Providence Health Plan is an HMO and HMO-POS health plan with a Medicare contract. Enrollment in Providence Health Plan depends on contract renewal. Section 1 Introduction to the Summary of Benefits for

More information

Legacy Health Medicare Advantage Plan

Legacy Health Medicare Advantage Plan Legacy Health Medicare Advantage Plan Thank you for your interest in applying for the Legacy Health Medicare Advantage plan powered by Moda Health. Below are links to the items which are part of the Enrollment

More information

Summary of Benefits. Health Partners Medicare Special (HMO SNP) 153967 HPM-415-15 SNP Benefits Book.indd 1

Summary of Benefits. Health Partners Medicare Special (HMO SNP) 153967 HPM-415-15 SNP Benefits Book.indd 1 2016 Health Partners Medicare 901 Market Street, Suite 500 Philadelphia, PA 19107 Visit us at HPPMedicare.com Summary of Benefits Health Partners Medicare Special (HMO SNP) H9207_HPM-415-16 Accepted 9/2015

More information

MA Plan (HMO) Plan 006. Summary of Benefits. Offered by. H5826_MA_194_2015_v_01_SB006 Accepted

MA Plan (HMO) Plan 006. Summary of Benefits. Offered by. H5826_MA_194_2015_v_01_SB006 Accepted MA Plan (HMO) Plan 006 2015 Summary of Benefits Offered by H5826_MA_194_2015_v_01_SB006 Accepted Blank Inside Front Cover Section I Introduction to the Summary of Benefits for Community HealthFirst MA

More information

Effective January 1, 2014 through December 31, 2014

Effective January 1, 2014 through December 31, 2014 Summary of Benefits Effective January 1, 2014 through December 31, 2014 The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.

More information

2014 Medicare Advantage Summary of Benefits HNE MEDICARE PREMIUM NO RX (HMO) HNE MEDICARE BASIC NO RX (HMO)

2014 Medicare Advantage Summary of Benefits HNE MEDICARE PREMIUM NO RX (HMO) HNE MEDICARE BASIC NO RX (HMO) 2014 Medicare Advantage Summary of Benefits HNE MEDICARE PREMIUM NO RX (HMO) HNE MEDICARE BASIC NO RX (HMO) HNE MEDIC ARE ADV ANTAGE ENROLLMENT KIT 2014 H8578_2014_034 Accepted SECTION I - INTRODUCTION

More information

2015 SUMMARY OF BENEFITS MICHIGAN: H5926 PLAN 001

2015 SUMMARY OF BENEFITS MICHIGAN: H5926 PLAN 001 2015 SUMMARY OF BENEFITS MICHIGAN: H5926 PLAN 001 MOLINA MEDICARE OPTIONS PLUS (HMO SNP) Genesee, Kent, Lapeer, Macomb, Montcalm, Oakland, Saginaw, and Wayne H5926_15_1061_0001_MISB Accepted 43005MED0714

More information

Medicare Advantage Plan Information

Medicare Advantage Plan Information Medicare Advantage Plan Information Thank you for your interest in applying for the HealthNet Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet you would receive

More information

January 1, 2015 December 31, 2015. Summary of Benefits. Advantra Total Care (HMO) H2672-010 80.06.360.1-AR1 A

January 1, 2015 December 31, 2015. Summary of Benefits. Advantra Total Care (HMO) H2672-010 80.06.360.1-AR1 A January, 205 December 3, 205 Summary of Benefits H2672-00 80.06.360.-AR A Y0022_205_H2672_00_ARa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what

More information

Blue Shield 65 Plus (HMO) summary of benefits

Blue Shield 65 Plus (HMO) summary of benefits Blue Shield 65 Plus (HMO) summary of benefits Group Medicare Advantage-Prescription Drug Plan for San Francisco Health Service System (SFHSS) January 1, 2016 to December 31, 2016 Blue Shield of California

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Value (HMO-POS) Value Plus (HMO-POS) Essentials Rx (HMO-POS) Classic (HMO-POS) (H2459) January 1, 2015 - December 31, 2015 Minnesota H2459_082914_4 CMS Accepted (09032014) SECTION

More information

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Senior Advantage Medicare Medicaid Plan (HMO SNP) Atlanta Metro Area Kaiser Foundation Health Plan of Georgia, Inc. Georgia Region A nonprofit corporation Health Maintenance Organization

More information

Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare

Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 24 (HMO-POS). Next year, there will

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Colorado Access Advantage Summit Plan (HMO SNP) COLORADO ACCESS ADVANTAGE SUMMIT PLAN (HMO SNP) Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8697_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan

More information

2014 Summary of Benefits

2014 Summary of Benefits 2014 Summary of Benefits An Independent Licensee of the Blue Cross and Blue Shield Association SM P.O. BOX 15349 Tallahassee, Florida 32317-5349 H5938_DP 471 CMS Accepted 08312013 SECTION I INTRODUCTION

More information

L.A. Care s Medicare Advantage Special Needs Plan

L.A. Care s Medicare Advantage Special Needs Plan L.A. Care s Medicare Advantage Special Needs Plan Summary of Benefits 2008 for people with Medicare and Medi-Cal Thank you for your interest in L.A. Care Health Plan. Our plan is offered by L.A. CARE

More information

Moda Health Medicare Advantage Plan

Moda Health Medicare Advantage Plan Moda Health Medicare Advantage Plan Thank you for your interest in applying for the Moda Health Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet you would receive

More information

Summary of Benefits for CareMore Connect (HMO SNP)

Summary of Benefits for CareMore Connect (HMO SNP) Summary of Benefits for CareMore Connect (HMO SNP) Available in Los Angeles County (partial) SBLACNT15 Y0017_15_081477A CHP CMS Accepted (09082014) Section I: Introduction to Summary of Benefits You have

More information

MEDICARE SUMMARY OF BENEFITS. Miami-Dade County

MEDICARE SUMMARY OF BENEFITS. Miami-Dade County MEDICARE SUMMARY OF BENEFITS Miami-Dade County SUMMARY OF BENEFITS MIAMI-DADE COUNTY Thank you for your interest in AvMed Medicare Choice. This booklet gives you a summary of what we cover and what you

More information

January 1, 2015 December 31, 2015

January 1, 2015 December 31, 2015 Summary of Benefits, and without Rx (HMO-POS) CMS Contract # H3328 January 1, 2015 December 31, 2015 Thank you for your interest in s. Our plans are offered by New York State Catholic Health Inc. /Fidelis

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

January 1, 2016 December 31, 2016. Summary of Benefits. Advantra Connect Plus (PPO) H7301-008 H7301.008.1

January 1, 2016 December 31, 2016. Summary of Benefits. Advantra Connect Plus (PPO) H7301-008 H7301.008.1 January 1, 2016 December 31, 2016 Summary of Benefits H7301-008 H7301.008.1 Y0001_2016_H7301_008 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

2013 SUMMARY OF BENEFITS

2013 SUMMARY OF BENEFITS 2013 SUMMARY OF BENEFITS COVENTRY HEALTH CARE OF FLORIDA, INC. Coventry Vista Value (HMO) H1076-010 Y0022_CCP_2013_H1076_010_SBa accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your

More information

that contracts with the Federal government.

that contracts with the Federal government. Introduction to the Summary of Benefits Report for,, and January 1, 2013 December 31, 2013 Metro Rochester SECTION I INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your interest in, Value Plus, Optimum

More information

An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits

An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits The chart below presents the list of benefits covered by Medicare, and

More information

Altius Medicare Advantage Plan Information

Altius Medicare Advantage Plan Information Altius Medicare Advantage Plan Information Thank you for your interest in applying for the Altius Health Plans Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet

More information

Aetna Medicare Advantage Plan Information

Aetna Medicare Advantage Plan Information Aetna Medicare Advantage Plan Information Thank you for your interest in applying for the Aetna Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet you would receive

More information

2015 Summary of Benefits Platinum and Gold Plans (HMO) Queens, Manhattan, and the Bronx. January 1, 2015 - December 31, 2015

2015 Summary of Benefits Platinum and Gold Plans (HMO) Queens, Manhattan, and the Bronx. January 1, 2015 - December 31, 2015 2015 Summary of Benefits Platinum and Gold Plans (HMO) Queens, Manhattan, and the Bronx January 1, 2015 - December 31, 2015 H4866_AM4004 Accepted 09212014 Proposed Effective Date: Primary Care Provider:

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Seniority Plus Amber II (HMO SNP) Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Stanislaus and Tulare counties,

More information

Summary of Benefits. Offered by. H5826_MA_194_2012_v_01_SB006 CMS Approved 08.24.2011

Summary of Benefits. Offered by. H5826_MA_194_2012_v_01_SB006 CMS Approved 08.24.2011 2012 Summary of Benefits Offered by H5826_MA_194_2012_v_01_SB006 CMS Approved 08.24.2011 Section I Introduction to the Summary of Benefits for Community HealthFirst MA Plan (HMO) January 1, 2012 - December

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits (Contract H3449, Plans 005, 012, 013, and 016) January 1, 2016 December 31, 2016 Y0079_7234 CMS Accepted 08312015 U5047h, 8/15 PAGE 1 of 36 Section I - Introduction to Summary

More information

Introduction to the Summary of Benefits Report For Denver Health Medicare Select (HMO) January 1, 2014 December 31, 2014 Denver County

Introduction to the Summary of Benefits Report For Denver Health Medicare Select (HMO) January 1, 2014 December 31, 2014 Denver County Introduction to the Summary of Benefits Report For Denver Health Medicare Select (HMO) January 1, 2014 December 31, 2014 Denver County SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your

More information

2010 SUMMARY OF BENEFITS

2010 SUMMARY OF BENEFITS 2010 SUMMARY OF BENEFITS Advantra Platinum PPO SD (PPO) Partial South Dakota H0370 001 Coventry Health and Life Insurance Company (South Dakota) M0003_H0370_001_2010SB CMS Approved Date:09/02/2009 SB-10-IA5

More information