D-SNP Benefits. A Quick Guide to Understanding the AmeriHealth VIP Care D-SNP Benefits

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "D-SNP Benefits. A Quick Guide to Understanding the AmeriHealth VIP Care D-SNP Benefits"

Transcription

1 D-SNP Benefits A Quick Guide to Understanding the AmeriHealth VIP Care D-SNP Benefits

2 Benefits Why AmeriHealth VIP Care Was Created The dual-eligible special needs Medicare Advantage plan, AmeriHealth VIP Care, was created to coordinate Medicare and Medicaid services, simplify the delivery system and to streamline payment to the provider. The goals of creating this plan are: Improve health outcomes. Keep beneficiaries in the community. Provide enhanced benefits in addition to Medicare and Medicaid benefits. 2

3 Benefits AmeriHealth VIP Care Plan Overview AmeriHealth VIP Care provides Medicare Parts A, B and D and additional services. AmeriHealth VIP Care also coordinates the care of members who are receiving Medicaid benefits from the state. The plan s service area includes the following counties: Lancaster, Lehigh and Northampton. 3

4 Benefits Medicare vs. Medicaid: Which Program Pays for Which Service? Plan name Medicare Parts A and B Medicare Part D Medicaid Medicaid Pennsylvania Department of Public Welfare (PA DPW) N/A N/A X Medicare Advantage MAPD X X Not applicable for nondual-eligible Medicare beneficiaries Fee-for-service (FFS) for dual-eligible beneficiaries Dual-eligible special needs plans (D-SNP) AmeriHealth VIP Care X X State 4

5 Benefits PA 2014 Eligibility Guidelines for the Medicare Savings Program Qualified Medicare Beneficiary (QMB, QMB+) Specified Low- Income Medicare Beneficiary (SLMB, SLMB+) 2014 Eligibility Guidelines for the Medicare Savings Programs Monthly Income* Assets** Benefits*** (All States and DC, except Alaska and Hawaii) State pays for (All States and DC, except Alaska and Hawaii) 100% FPL individual's $7,160 - individual $993 - individual copays and $10,570 - couple $1,331 - couple premiums (All States and DC, except Alaska and Hawaii) 100%-120% FPL $993-$1,187 - individual $1,331-$1,594 - couple (All States and DC, except Alaska and Hawaii) $7,160 - individual $10,750 - couple State pays for individual's copays and premiums * Federal poverty levels are updated each year, usually in January or February. ** Asset limits can change each year and are usually updated in December for the following year. ***Benefits differ from state to state; this graph refers to PA benefits only. 5

6 Benefits Medicare Part A and B Benefits * Ambulance services. Cardiac and pulmonary rehabilitation services. Catastrophic coverage. Chiropractic care. Dental services. Diabetes program and supplies. Diagnostic tests, X-rays, lab services and radiology services. Doctor office visits Durable medical equipment. Emergency care. Hearing services. Home health care. Hospice initial consultation. Inpatient hospital care. Inpatient mental health care. LTC pharmacy. Mail order prescriptions. Out-of-network catastrophic coverage. Out-of-network catastrophic prescriptions. Out-of-network initial coverage. Outpatient mental health care. Outpatient prescription drugs. Outpatient rehabilitation. Outpatient services and surgery. Outpatient substance abuse care. Pharmacy. Podiatry. Preventive services and wellness education. Prosthetic devices. Skilled nursing facility services. Urgent care. *Exceptions may apply, see provider manual for full list of benefits. Referral or prior authorization may be required. 6

7 Benefits Supplemental Benefits: Dental, Vision and Hearing Dental services Preventive dental Oral exams: one every six months. Cleaning: one every six months. Fluoride treatment: one every six months. Dental X-rays: one every year. Non-routine services, including minor restorations such as fillings, simple extractions and denture repair. Comprehensive dental Non-routine services. $500 every two years. Coverage for minor restorations. Fillings, simple extractions and denture repair. Vision services Up to one supplemental routine eye exam every year. Up to one pair of eyeglasses or contact lenses every two years. Hearing services Up to one supplemental routine hearing exam every year. Up to one fitting evaluation for a hearing aid every three years. Up to $1,000 coverage for hearing aids every three years. 7

8 Benefits Supplemental Benefits (Continued): OTC and Transportation Over the counter (OTC) Typically includes medicines or products that alleviate or treat injuries or illness. May use the benefit without a statement or documentation of a diagnosis from a medical provider. Up to $60 every three months. No rollover quarter to quarter. Member may fill out OTC Catalog or call Member Services at to order OTC products. Convey Health Solutions keeps track of OTC utilization and will inform members, providers and pharmacy when limit is reached. Transportation services Must be plan-approved location. Twenty-four (24) one-way trips per year to a plan-approved location. Car, shuttle and van services include nonemergent transportation to doctor visits, preventive services, pharmacies and fitness centers. Authorization and scheduling rules apply. Members may call Member Services at or their care managers to arrange transportation. 8

9 Benefits Supplemental Benefits (Continued): 24/7/365 Nurse Line If members are unable to reach their PCPs offices, registered nurses are available 24 hours/7 days to assist members through the toll-free AmeriHealth VIP Care Nurse Call Line at

10 Benefits Supplemental Benefits (Continued): Care Management Team The Care Management Team (CMT) consists of care managers (nurses and social workers) trained to help members investigate and overcome barriers to achieve their health care goals. Outreach services include: Contacting members. Educating members. Calling providers. Calling pharmacies. Completing surveys and assessments to support special projects. Providers may request CMT support directly by calling toll-free: , 8 a.m. 5 p.m., Monday through Friday. 10

11 Benefits Additional Information For additional information on benefits, please refer to the Provider Manual or call Provider Services at

12

First Choice VIP Care PLUS. Healthy Connections Prime Medicare Medicaid Benefits

First Choice VIP Care PLUS. Healthy Connections Prime Medicare Medicaid Benefits First Choice VIP Care PLUS Healthy Connections Prime Medicare Medicaid Benefits Benefits Why First Choice VIP Care PLUS Was Created The Medicare Medicaid Plan, First Choice VIP Care PLUS, was created to

More information

Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per

Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket

More information

Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary

Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary 5 Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Plans Medicare members, by plan. Topics: Health

More information

Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary

Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary 5 Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Medicare members, by plan. Topics: Health Partners

More information

Section IV - Information for People with Medicare and Medicaid

Section IV - Information for People with Medicare and Medicaid TM Section IV - Information for People with Medicare and People who qualify for Medicare and are known as dual eligibles. As a dual eligible, you are eligible for benefits under both the federal 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

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

[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

Service AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network

Service AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network 2016 Medicare Advantage Plans Comparison Chart This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network

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

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

Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes

Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes Quick Guide 2016 $0 mium* Plan Pre Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes *You must continue to pay your Medicare Part B premium. H1961_PH16C65S1QG Accepted Thank

More information

2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County

2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County 2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people

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

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

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

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna-HealthSpring Preferred KNX (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred KNX (HMO). Next year, there

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

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

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

PROVIDENCE MEDICARE ADVANTAGE PLANS. 2015 Plan Comparison Western Oregon and Clark County Washington H9047_2015PHP40_ACCEPTED

PROVIDENCE MEDICARE ADVANTAGE PLANS. 2015 Plan Comparison Western Oregon and Clark County Washington H9047_2015PHP40_ACCEPTED PROVIDENCE MEDICARE ADVANTAGE PLANS 2015 Plan Comparison Western Oregon and Clark County Washington H9047_2015PHP40_ACCEPTED Service area map Columbia River Washington Oregon Clark Providence Medicare

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

Benefits At A Glance Plan C

Benefits At A Glance Plan C Benefits At A Glance Plan C HIGHLIGHTS OF WELFARE FUND BENEFITS WELFARE FUND BENEFITS IN BRIEF Medical and Hospital Benefits Empire BlueCross BlueShield Plan C-1 Empire BlueCross BlueShield Plan C-2 All

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

Annual Notice of Changes for 2014

Annual Notice of Changes for 2014 True Blue Rx Option II (HMO) offered by Blue Cross of Idaho Health Service, Inc. (Blue Cross of Idaho) Annual Notice of Changes for 2014 You are currently enrolled as a member of True Blue Freedom (HMO).

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

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

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

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

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

BluePrint Bronze Tribal Zero Cost Share Plan 458a Coverage Period: Beginning on or after 01-01-2015

BluePrint Bronze Tribal Zero Cost Share Plan 458a Coverage Period: Beginning on or after 01-01-2015 BluePrint Bronze Tribal Zero Cost Share Plan 458a Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 01-01-2015 Coverage for: Single and family

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS Employee Premium None None None None None Explanation of Plans and Options Available to You Deductible Annual Out-of-Pocket Calendar Year (Applicable to members who reside in California & Nevada Only.)

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

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

More value Thank you for considering KPS You Need a Plan that Offers a Free Prescription Drug Discount Program

More value Thank you for considering KPS You Need a Plan that Offers a Free Prescription Drug Discount Program More value Thank you for considering KPS KPS Health Plans was established in Bremerton, Washington in 1946. We are a Washington state nonprofit health care service contractor offering preferred provider

More information

Aetna Medicare Advantage HMO SHBP Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Aetna Medicare Advantage HMO SHBP Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.state.nj.us/treasury/pensions/health-benefits.shtml or

More information

Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered.

Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered. Covered Benefits Services Abortions Allergy Testing Audiology Birth Control Services Blood & Blood Plasma Bone Mass Measurement (bone density) Case Management Chemotherapy Chiropractor Services (manipulation/subluxation)

More information

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna HealthSpring Preferred KNX (HMO) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna HealthSpring Premier KNX (HMO POS). Next year, there

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

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna HealthSpring Preferred NGA (HMO) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna HealthSpring Premier NGA (HMO POS). Next year, there

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

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

BlueConnect HSA Bronze $3,500 Plan 457 Coverage Period: Beginning on or after 01-01-2015

BlueConnect HSA Bronze $3,500 Plan 457 Coverage Period: Beginning on or after 01-01-2015 BlueConnect HSA Bronze $3,500 Plan 457 Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 01-01-2015 Coverage for: Single or Family Plan Type:

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

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Cigna HealthSpring Premier (HMO POS) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Premier (HMO POS). Next year, there will

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

StudentBlue University of Nebraska

StudentBlue University of Nebraska Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO What is the overall deductible? This is only a summary. If you want more details about

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

Medicare Options For Retiree/Direct Bill Members

Medicare Options For Retiree/Direct Bill Members Open Enrollment 2014 State Employee Health Plan Medicare Options For Retiree/Direct Bill Members Comparison Chart 2 2013 **Cover photo is titled Road into the Field from the Postcards from Kansas collection

More information

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be

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

$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific

$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.teamsters-hma.com or by calling 1-866-331-5913.

More information

Lesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip

Lesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip HOSPITAL SERVICES Hospital Inpatient : Paid in full, Non-network: Hospital charges subject to 10% of billed charges up to coinsurance maximum. Non-participating provider charges subject to Basic Medical

More information

Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members

Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Benefits Effective January 1, 2012 UHAZ12HM3349753_000 H0303_110818_013543 Summary of the UnitedHealthcare plans

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 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

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

Benefits at a Glance: Visa Inc. Policy Number: 00784A

Benefits at a Glance: Visa Inc. Policy Number: 00784A Benefits at a Glance: Visa Inc. Policy Number: 00784A Visa Inc. Benefits at a Glance Policy #00784A Effective Date: January 1, 2016 Visa Inc. offers Medical, Pharmacy, Vision, Dental and Medical Evacuation

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

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, 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

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....

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

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

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

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

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

Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services

Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services Most adults who qualify for the Medicaid category known as the Other Adult Group receive services under the New

More information

SUMMARY OF BADGERCARE PLUS BENEFITS

SUMMARY OF BADGERCARE PLUS BENEFITS SUMMARY OF BADGERCARE PLUS BENEFITS Medical, mental health and substance abuse services Dental emergency NOT Pharmacy, chiropractic and dental services NOT 13 Ambulatory surgery centers Coverage of certain

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

Health Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436.

Health Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436. Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage for: Individual Family Plan Type: HMO This is only a summary.

More information

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplanoperations@umchealthsystem.com or by calling

More information

Orange County Benefit Highlights. Orange County. SCAN Classic (HMO), SCAN Balance (HMO SNP), and Heart First (HMO SNP) 2015 Benefit Highlights

Orange County Benefit Highlights. Orange County. SCAN Classic (HMO), SCAN Balance (HMO SNP), and Heart First (HMO SNP) 2015 Benefit Highlights Orange County Benefit Highlights Orange County SCAN Classic (HMO), SCAN Balance (HMO SNP), and Heart First (HMO SNP) 2015 Benefit Highlights Orange County Benefit Highlights Comprehensive Care SCAN CLASSIC

More information

2016 Riverside Medical Clinic Contracted Medicare Advantage Health Plan Benefit Comparison

2016 Riverside Medical Clinic Contracted Medicare Advantage Health Plan Benefit Comparison Riverside Medical Clinic Contracted Medicare Advantage Health Plan AARP Medicare Complete Plan 1 [Secure Horizons] 1-877-596-3258 Anthem MediBlue Select 1-800-797-6438 Health Net Healthy Heart ** 1-800-

More information

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C Service Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ Division of Developmental Disabilities (DDD) NJ FamilyCare B NJ FamilyCare C NJ FamilyCare D Abortions and related services (covered

More information

Napa and Sonoma Counties

Napa and Sonoma Counties Napa and Sonoma Counties Benefit Highlights Napa and Sonoma Counties SCAN Classic (HMO), SCAN Balance (HMO SNP), and Heart First (HMO SNP) 2015 Benefit Highlights Napa and Sonoma Counties Benefit Highlights

More information

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

VIP HMO MEDICARE PLAN 2014 Summary of Benefits For Medicare-Eligible Retirees Residing in Manhattan, Brooklyn, Bronx, Staten Island & Queens

VIP HMO MEDICARE PLAN 2014 Summary of Benefits For Medicare-Eligible Retirees Residing in Manhattan, Brooklyn, Bronx, Staten Island & Queens 214 Summary of Benefits PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, Speech & Occupational Therapy Flu & Pneumonia Vaccinations Diagnostic

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

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES PPO Kaiser Permanente For Non-PPO Providers Employee Premium None None None None None Explanation of s and Options Available to You If you choose a doctor who is not contracted with Anthem Blue Cross the

More information

AETNA BETTER HEALTH SM PREMIER PLAN Summary of Benefits

AETNA BETTER HEALTH SM PREMIER PLAN Summary of Benefits AETNA BETTER HEALTH SM PREMIER PLAN Summary of Benefits Aetna Better Health SM Premier Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Illinois Medicaid to provide

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). Eligibility for this program will be determined

More information

Introduction to the Summary of Benefits for Traditional Blue Medicare PPO 701 Plus, 751 Part D and 752 Part D

Introduction to the Summary of Benefits for Traditional Blue Medicare PPO 701 Plus, 751 Part D and 752 Part D Introduction to the Summary of Benefits for, 751 Part D and 752 Part D January 1, 2007 - December 31, 2007 BlueCross BlueShield of Western New York CMS Contract #H5526 Thank you for your interest in PPO.

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

Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gallagherkoster.com/colgate or by calling 1 877-371-9621.

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

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

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

Coverage for: Individual Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage for: Individual Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important

More information

60769MN0030057_00_SBC.pdf 60769MN0030041. Coverage for: Family Plan Type: PPO. Important Questions Answers Why this Matters:

60769MN0030057_00_SBC.pdf 60769MN0030041. Coverage for: Family Plan Type: PPO. Important Questions Answers Why this Matters: Federated Mutual Insurance Company: 1505 Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Family Plan Type: PPO This is only

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

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? Is there an out of pocket limit on my expenses? What is not included in

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires Covered Member to be Enrolled in Both Medicare Parts A & B Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement Not Applicable Not Applicable

More information

Important Questions Answers Why this Matters: In-network: $2,000 Single / $4,000 Family Out-of-network: $3,000 Single / $6,000 Family

Important Questions Answers Why this Matters: In-network: $2,000 Single / $4,000 Family Out-of-network: $3,000 Single / $6,000 Family This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.independenthealth.com or by calling 1-800-501-3439. Important

More information

About to Retire: Preparing for Medicare Patient Financial Services Agenda Medicare Enrollment Covered Services Medicare-covered covered Preventive Services Agenda, continued Advance Beneficiary Notice

More information

Bronze HSA 3250 Coinsurance 50

Bronze HSA 3250 Coinsurance 50 Bronze HSA 3250 Coinsurance 50 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: Beginning on or after 01/01/2016 Coverage for: Individual and Individual + Family

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

What is the overall deductible? Are there other deductibles for specific services?

What is the overall deductible? Are there other deductibles for specific services? : MyPriority POS RxPlus Silver 1800 Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Subscriber/Dependent Plan Type:

More information

Summary of Services and Cost Shares

Summary of Services and Cost Shares Summary of Services and Cost Shares This summary does not describe benefits. For the description of a benefit, including any limitations or exclusions, please refer to the identical heading in the Benefits

More information