2017 NMRHCA Benefits Presentation
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1 2017 NMRHCA Benefits Presentation Presbyterian Senior Care (HMO-POS) Plan I and Plan II _[code]_[mmddyyyy]
2 Who we are Started in 1908 as a Tuberculosis Sanatorium Presbyterian Today Locally owned, nonprofit healthcare system in New Mexico, serving one in three residents More than 750,000 customers Fully integrated with a delivery system, physician group, and Presbyterian Health Plan 8 Hospitals Presbyterian Medical Group 850+ providers Presbyterian Health Plan 470,000 members 2
3 Medicare basics A federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Part A - Hospital insurance (inpatient) Part B - Medical insurance (outpatient) Part C - Medicare Advantage plans Part D - Medicare prescription drug coverage 3
4 Include: MEDICARE ADVANTAGE PLANS Presbyterian Senior Care (HMO-POS) NMRHCA Plans Benefits available for services from either innetwork or out-of-network providers. Emergency and urgent care coverage anywhere in the world Preventive services, routine eye exams, and gym memberships at no additional cost to you Referrals are not required Video Visits provides for a new way to see a provider for non-emergencies A convenient and secure website just for members 4
5 Who is eligible? Must have both Medicare Part A and Part B. Must live in the service area: Presbyterian Senior Care (HMO-POS) service area is Statewide 5
6 2017 Presbyterian Senior Care (HMO-POS) NMRHCA Benefits Plan I In-Network Plan II In-Network Out-of- Network Out-of-Pocket Maximum $2,500 $3,000 $7,500 (combined) Office Visits and Tests Preventive Care, Screenings $0 $0 $35 Primary Care Office Visit $10 $10 $35 Specialist Office Visit $30 $40 $60 Diagnostic Tests, Lab Services, Imaging $0 $0 10% - 20% MRI/MRA, CT Scan PET Scan $0 $250 20% Acupuncture (20 visits/year) $15 $15 $60 Chiropractor (Medicare covered) $20 $20 $60 Podiatry Services (Medicare covered) $0 $0 $60 Vision Exams (annual routine exam and exams to diagnose and treat diseases and conditions of the eye). 6 $0 for first exam; specialist copay thereafter $60
7 2017 Presbyterian Senior Care (HMO-POS) NMRHCA Benefits Plan I In-Network Plan II In-Network Out-of- Network Emergency, Urgent & Video Visits Video Visits $0 $0 $35 Urgent Care $10 $10 $65 Emergency Care (worldwide) waived if admitted $65 $65 $65 Ambulance Services $75 $150 $75 - $150 Inpatient and Outpatient Coverage Inpatient Hospital (per admission) Days 1-3 Additional Days $125 per day $0 $225 per day $0 Outpatient Surgery $125 $225 20% Outpatient Mental Health Care $0 $0 50% $750 per admit 7
8 2017 Presbyterian Senior Care (HMO-POS) NMRHCA Benefits Plan I In-Network Plan II In-Network Out-of- Network Home Health & Rehabilitation Home Health Care $0 $0 $0 Cardiac and Pulmonary Rehab $0 $0 $35 Other Rehabilitative Services $10 $15 $35 Durable Medical Equipment $10 10% 25% Diabetes Supplies $0 $0 25% Skilled Nursing Facility Days 1-20 Days (limited to 100 days per benefit period) $0 per day $40 per day $0 per day $40 per day $0 per day $60 per day Drugs Covered Under Medicare Part B Select oral immunosuppressant and nebulized inhaled medications Chemotherapy and other Part B-covered drugs $0 when purchased through a retail pharmacy $0 0% 10% 20%
9 2017 NMRHCA Plan I drug benefits Coverage Starts Catastrophic Coverage There is no coverage limit and no coverage gap with Plan I Part D Covered Drugs 30-day supply 90-day mail order 30-day supply Tier 1: Preferred Generic Tier 2: Generic Tier 3: Preferred Brand Tier 4: Non- $5 $10 $5 $10 $30 $75 $55 $ $3.30 or 5%, whichever is greater $8.25 or 5%, whichever is greater You stay in this stage for the rest of the year. Preferred Brand Tier 5: Specialty $200 NA Drugs Catastrophic coverage begins after your out-of-pocket costs=$4,950
10 2017 NMRHCA Plan II drug benefits Coverage Starts Coverage Gap Donut Hole Catastrophic Coverage Initial coverage limit $3,700: includes what both you and your plan pay Part D Covered Drugs 30-day supply 90-day mail order 30-day supply 90-day mail order 30-day supply Tier 1: Preferred Generic Tier 2: Generic Tier 3: Preferred Brand Tier 4: Non- Preferred Brand $4 $8 $10 $20 $45 $ $95 $285 $4 $8 $10 $20 40% 40% 40% 40% $3.30 or 5%, whichever is greater $8.25 or 5%, whichever is greater You stay in this stage for the rest of the year. Tier 5: Specialty Drugs 33% NA 40% NA Catastrophic coverage begins after your out-of-pocket costs=$4,950
11 Prescription drug formulary A list of drugs selected by Presbyterian Health Plan which represents the prescription therapies believed to be a necessary part of a quality treatment program. Quantity limits and restrictions may apply and are noted in the formulary with the following abbreviations: PA = Prior Authorization QL = Quantity Limits ST = Step Therapy What if your drug is not on our formulary? Call us and ask for a list of similar drugs that are covered. You can ask us to make an exception to cover your drug. 14
12 Managing your healthcare Care management Trained registered nurse care managers assist with various health concerns and can help coordinate services between providers and patients. Disease management Help members with certain diseases manage their health. Utilization management reviews 19 Pre-service, Urgent Concurrent and Post-service reviews ensure you receive the most appropriate treatment.
13 Financial Assistance MEDICARE ADVANTAGE PLANS You may qualify for money-saving programs based on your income to help you pay your plan premiums and drug copays. Extra Help (also called Low-Income Subsidy) assists you with prescription drug premiums, copays, and other costs. Income and asset limits apply. The Medicare Savings Program (MSP) helps you pay for Medicare Part A and/or Part B premiums. Call for more information. 15
14 Presbyterian Senior Care (HMO-POS) NMRHCA Plans Point of Service (POS) You can choose to go In-network or Outof-network to access your benefits PresRN A nurse advice line available 24 hours a day, 7 days a week, including holidays. SilverSneakers Fitness Memberships Visit more than 10,000 participating locations at no additional cost to you. Video Visits Be seen by a medical provider for your non-urgent medical questions anytime, anywhere 16 MyPres Secure online access to review drug and medical claims, order member ID card and more.
15 Presbyterian Customer Service Center (Located in Albuquerque) (505) or (TTY 711) 8 am to 8 pm, seven days a week Presbyterian Sales Consultants (505) or (TTY 711) 8 am to 8 pm, seven days a week Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO are Medicare Advantage plans with a Medicare contract. Enrollment in these plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
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2019 Summary of Benefits CHRISTUS Health Plan Generations H1189, Plan 003 This is a summary of drug and health services covered by CHRISTUS Health Plan Generations, January 1, 2019 December 31, 2019. CHRISTUS
2019 Allwell Medicare (HMO) H6550: 003 Cherokee, Crawford and Sedgwick Counties, KS
2019 Allwell Medicare (HMO) H6550: 003 Cherokee, Crawford and Sedgwick Counties, KS H6550_19_7950SB_003_M_Accepted 09072018 This booklet provides you with a summary of what we cover and the cost-sharing
2019 Summary of Benefits
2019 Summary of Benefits MVP Health Plan, Inc. GoldValue with Part D (HMO-POS) H3305: Plan 022 This is a summary of drug and health services covered by MVP Health Plan January 1, 2019 - December 31, 2019.
FirstMedicare Direct Healthy State HMO Prime (HMO) 2018 Summary of Benefits
Healthy State HMO Prime (HMO) 2018 Summary of Benefits This is a summary of drug and health services covered January 1, 2018-December 31, 2018 by the FirstMedicare Direct. The benefit information provided
FRESENIUS TOTAL HEALTH (HMO SNP)
Summary of Benefits FRESENIUS TOTAL HEALTH (HMO SNP) (a Medicare Advantage Health Maintenance Organization (HMO) offered by FRESENIUS HEALTH PLANS OF NORTH CAROLINA, INC. with a Medicare contract) Available
$15 copay $25 copay. in a specialist office. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum
Prepared for Genesee Area Healthcare Plan Effective: 01/01/2019 Plan Feature Highlights Annual deductible None $250 Annual out-of-pocket maximum (medical services only, does not include prescription drugs)
2019 Summary of Benefits
2019 Summary of Benefits MVP Health Plan, Inc. (HMO-POS) (HMO-POS) (HMO-POS) H3305: Plan 022, Plan 021 and Plan 020 This is a summary of drug and health services covered by MVP Health Plan January 1, 2019
Summary of Benefits. CareMore Care Access (HMO) - Medicare Only. Available in Pima County. SB_CM_AZ_CA Y0114_18_32747_U_028 CMS Accepted ( )
Summary of Benefits Available in Pima County SB_CM_AZ_CA Y0114_18_32747_U_028 CMS Accepted (10012017) Introduction This is a summary of health services and drugs covered by from January 1, 2018 - December
Summary of Benefits 1
Summary of Benefits Summary of Benefits January, 207 to December 3, 207. 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
Annual Notice of Changes for 2018
Geisinger Gold Preferred Complete Rx (PPO) offered by Geisinger Health Plan Annual Notice of Changes for 2018 You are currently enrolled as a member of Geisinger Gold Preferred Complete Rx (PPO). Next
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct HMO Plus (HMO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct HMO Plus (HMO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties P age 1 SECTION I - INTRODUCTION TO SUMMARY
2015 Summary of Benefits
2015 Summary of Benefits Health Net Ruby Select (HMO) San Francisco County, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0280 CMS Accepted 09032014
2019 Allwell Medicare Premier (HMO) H0351: 051 Maricopa and Pinal counties, AZ
2019 Allwell Medicare Premier (HMO) H0351: 051 Maricopa and Pinal counties, AZ H0351_19_7907SB_051_M_Accepted 09072018 This booklet provides you with a summary of what we cover and your cost-sharing responsibilities.
2019 Allwell Dual Medicare (HMO SNP) H5590: Maricopa, Pima and Yuma counties, AZ
2019 Allwell Dual Medicare (HMO SNP) H5590: 006-001 Maricopa, Pima and Yuma counties, AZ H5590_19_7908SB_006_001_M_Accepted 09072018 This booklet provides you with a summary of what we cover and the cost-sharing
2016 Summary of Benefits
2016 Summary of Benefits Health Net Gold Select (HMO) Riverside and San Bernardino counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0182 CMS Accepted 09092015
Medical Plan Options - Retirees Age 65 or Over/ Disabled Participants with Medicare Coverage
l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Program Name Group Prime Solution Group Prime Solution for Seniors for Seniors Type of Policy re Cost Plan with re Prescription Drug