AmeriHealth Medigap Plans Information. Individual health plan options for people with Medicare
|
|
- Suzanna Briggs
- 5 years ago
- Views:
Transcription
1 2016 AmeriHealth Medigap Plans Information Individual health plan options for people with Medicare AM6830 (5/15) 5823(10/15)BKV1
2
3 Thank you. We appreciate your interest in AmeriHealth New Jersey. We look forward to serving you as one of the many satisfied members who ve chosen us for our stability, reliability and solid, comprehensive coverage options. This booklet provides you with information on AmeriHealth Medigap Plans, our Medicare Supplement plans, also known as Medigap. Take a few minutes to look through it and decide which plan best fits your needs and budget. Of course, you can call us with any questions about plan coverage, including monthly premiums and cost-sharing. We ve included an enrollment form for your convenience. Simply complete the form and return in the postage-paid reply envelope provided. Thanks again for requesting this information and for choosing AmeriHealth New Jersey. Questions? Call AmeriHealth New Jersey at (TTY/TDD:711) Seven days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voic . Connect with us on Facebook: Contents Introduction Benefits at a glance Ready to enroll? Outline of coverage
4 3 steps to finding the right Medigap plan Follow these steps to find a Medicare Supplement plan that fits your budget, needs, and lifestyle Learn about the plans we offer Compare benefits, cost-sharing, and premiums Enroll in the plan you want Let s get started
5 Take a look at these 2 types of plans. They cover the costs not covered by Original Medicare. Medicare Advantage Plans These plans are offered by private insurance companies that are approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You ll get your Medicare Part A and Medicare Part B coverage from the Medicare Advantage plan. Medicare Advantage Plans must cover all of the services that Original Medicare covers. Medicare Advantage plans are not considered Medicare Supplement plans. Medicare Supplement Plans (Medigap) With this option, you remain enrolled in Original Medicare. When you buy a Medicare Supplement plan from a private insurance company, Original Medicare will pay its share of costs for covered services, then your supplement plan will pay its share. These plans do not include prescription drug coverage. While your monthly premium may be higher than a Medicare Advantage plan, many people choose them for lower copays, deductibles and coinsurance. AmeriHealth Medicare Advantage plans are underwritten by AmeriHealth HMO, Inc. AmeriHealth Medigap Plans are offered through AmeriHealth Insurance Company of New Jersey.
6 THIS PAGE INTENTIONALLY LEFT BLANK.
7 IN THIS SECTION Benefits at a glance
8
9 How to pick a plan: If you re looking for a plan with no network restrictions and no referrals AmeriHealth Medigap Plans may be the right choice for you. Choose coverage for Medicare s gaps, which may include deductibles, copayments, and coinsurance that you are left to pay under Original Medicare. AmeriHealth Medigap Plans offer a choice of four (A, C, F, and N) Medicare Supplement insurance (Medigap) plans that give you the freedom you want by allowing you to see any doctor who accepts Original Medicare. Questions? Call AmeriHealth New Jersey at (TTY/TDD:711) Seven days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voic . Connect with us on Facebook:
10 With AmeriHealth Medigap Plans: You re free to visit any doctor or hospital that accepts Original Medicare. There s no need to select a primary care physician. You don t need a referral to see a specialist. You re covered when you travel anywhere in the United States. You get emergency coverage outside of the United States (with plan C, F, or N). You have the option to enroll in a stand-alone Part D prescription drug plan. Our recommended Plan F pays all deductibles, all coinsurance, and the 20 percent of Part B expenses not paid by Original Medicare. With Plan N, you pay a lower monthly premium and share some of the costs with the plan like up to a $20 copayment for doctor visits. You ll also have access to our Healthy Lifestyles SM Solutions: Tobacco Cessation Program You may receive up to $150 reimbursement for completing an approved tobacco cessation program. Weight Management Program You may also receive up to $150 reimbursement for participating in an approved weight management program. Fitness Reimbursement Up to $150 reimbursement after 120 workouts in 365 days at an approved gym. Plus, you ll receive TruHearing discounts: TruHearing provides dicounted rates on hearing aids through a national provider network. AmeriHealth Medigap Plans are offered through AmeriHealth Insurance Company of New Jersey. AmeriHealth Medigap Plans plans provide hospital and medical coverage only. They do not include Medicare prescription drug benefits. TruHearing is a registered trademark of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners.
11 Terms to know: This quick list of Medicare-related terms will help you better understand the information in this Plan Information Book. Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. Coinsurance: An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent). Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor s visit or prescription drug. Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
12 Comparison of Plans Please refer to the AmeriHealth Medigap Plans Outline of Coverage for copy and rate information. Service category Medicare pays: Plan A You pay: Primary care physician visits Specialist visits Emergency room Urgent care Outpatient surgery 80% of Medicare-approved amounts after your annual Part B deductible is met Part B deductible (Plan pays 20% coinsurance) Inpatient hospital All charges except your Part A deductible and Part A coinsurance Part A deductible Part B excess charges* Nothing 100% * If the amount a doctor or other health care provider charges is higher than the Medicare-approved amount, the difference is called the excess charge.
13 AmeriHealth Medigap Plans Plan C You pay: Plan F You pay: Plan N You pay: $0 (Plan pays Part B deductible and 20% coinsurance) $0 (Plan pays Part B deductible and 20% coinsurance) Part B deductible; copay for doctor visits; copay for emergency room (waived if admitted) (Plan pays all other Part B coinsurance) $0 $0 $0 100% $0 100% These plans do not cover Medicare Part D prescription drug benefits, but will work with any stand-alone Medicare Part D prescription drug plan. Medicare Part D plans help cover the costs of Medicare-covered prescription drugs. You don t have to choose a prescription drug plan, but if you decide to choose a Medicare Part D prescription drug plan after your initial enrollment period or after 63 days lapse in creditable coverage, you may be subject to a Late Enrollment Penalty.
14 THIS PAGE INTENTIONALLY LEFT BLANK.
15 IN THIS SECTION Ready to enroll?
16
17 Ready to sign up for one of the AmeriHealth Medigap Plans? Here are easy step-by-step instructions for filling out the enrollment form. SECTION Personal Information A Please check [ ] the box in front of the plan you want to enroll in. Then, provide the personal information requested. SECTION Medicare Insurance Information B You will need your Medicare card to complete this section. You must include your Medicare claim number on your application form. SECTION C Important Questions Please answer the questions in Part 1 and Part 2 of this section. SECTION D Important Information Please read the important information regarding eligibility. SECTION E Your Signature Please read the information provided, then sign and date your application form. You do not need to complete Section F. This section is to be completed by the certified agent. Applicants have a right to return this Policy within (30) days of delivery for refund of the full premium paid if, after examination of this Policy, the Applicant is not satisfied for any reason. This Policy may be returned to AmeriHealth Medigap Plans, 1901 Market Street, Philadelphia, Pa If the Policy is returned, it will be null and void from the beginning and no benefits will be payable under its terms. Questions? Call AmeriHealth New Jersey at (TTY/TDD:711) Seven days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voic . Connect with us on Facebook: (10/15)EI
18 THIS PAGE INTENTIONALLY LEFT BLANK.
19 IN THIS SECTION Outline of Coverage
20
21 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Basic, including 100% Part B coinsurance AmeriHealth Insurance Company of New Jersey Outline of Medicare Supplement Coverage Benefit Plans Available: A, C, F and N Basic Benefits: Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end Medical expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments. Blood: First three pints of blood each year Hospice: Part A coinsurance A B C D F F* G K L M N Basic, including 100% Part B coinsurance Part A Deductible Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Part B Deductible Foreign Travel Emergency Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Foreign Travel Emergency Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Part B Deductible Part B Excess (100%) Foreign Travel Emergency Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Part B Excess (100%) Foreign Travel Emergency Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% 50% Skilled Nursing Facility Coinsurance 50% Part A Deductible Out-of-pocket limit $4,940; paid at 100% after limit reached Hospitalization and preventive care paid at 100%; other basic benefits paid at 75% 75% Skilled Nursing Facility Coinsurance 75% Part A Deductible Out-of-pocket limit $2,470; paid at 100% after limit reached Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance 50% Part A Deductible Foreign Travel Emergency Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and $50 copayment for ER Skilled Nursing Facility Coinsurance Part A Deductible Foreign Travel Emergency * Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan s separate foreign travel emergency deductible. Page INDIVIDUAL
22 AmeriHealth Insurance Company of New Jersey Medicare Supplement Premium Information AmeriHealth Insurance Company of New Jersey can only raise your premium if we raise the premium for all policies like yours in this State. We will not change your premium or cancel your policy because of age or poor health. These monthly rates are subject to change with the approval of the New Jersey Department of Banking and Insurance. Attained Age Rated Age 50-64* Age 65 Age 66 Age 67 Age 68 Age 69 Age 70 Age 71 Age 72 Age 73 Age 74 Age Age Age 85+ Plan A NT N/A $98.89 $ $ $ $ $ $ $ $ $ $ $ $ T N/A $ $ $ $ $ $ $ $ $ $ $ $ $ Plan C NT $ $ $ $ $ $ $ $ $ $ $ $ $ $ T $ $ $ $ $ $ $ $ $ $ $ $ $ $ Plan F NT N/A $ $ $ $ $ $ $ $ $ $ $ $ $ T N/A $ $ $ $ $ $ $ $ $ $ $ $ $ Plan N NT N/A $ $ $ $ $ $ $ $ $ $ $ $ $ T N/A $ $ $ $ $ $ $ $ $ $ $ $ $ *This includes people 50 and older and under 65 on Medicare due to disability. NT Non-Tobacco T Tobacco Non-Tobacco rates apply to applications submitted during the 6-month open enrollment or in a guaranteed issue situation. Applicants NOT enrolling during the 6-month open enrollment period or in a guaranteed issue situation will be evaluated for tobacco usage and charged the corresponding tobacco or non-tobacco rates. Page INDIVIDUAL
23 PREMIUM INFORMATION We, AmeriHealth Insurance Company of New Jersey, can only raise your premium if we raise the premium for all policies like yours in the State of New Jersey. Premiums for attained age plans A, C, F and N will increase beginning with the first full month that the member moved into a new age range in accordance with the premium schedule on the previous page. Disclosures Use this outline to compare benefits and premiums among policies. POLICY REPLACEMENT READ YOUR POLICY VERY CAREFULLY This is only an outline describing your policy s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company. RIGHT TO RETURN YOUR POLICY If you find that you are not satisfied with your policy, you may return it to AmeriHealth Medigap Plans, 1901 Market Street, Philadelphia, PA If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments. If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. NOTICE This policy may not fully cover all of your medical costs. AmeriHealth is not connected with Medicare. This Outline of Coverage does not give all of the details of Medicare coverage. Contact your local Social Security office or consult Medicare & You for more details. COMPLETE ANSWERS ARE VERY IMPORTANT When you fill out the application for the new policy, be sure to answer truthfully and complete any questions about your medical health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. Review the application carefully before you sign it. Be certain that all information has been properly recorded. Page INDIVIDUAL
24 Plan A * A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies. First 60 days All but $1,260 $0 $1,260 (Part A deductible) 61st through 90th day All but $315 a day $315 a day $0 91st day and after: While using 60 lifetime reserve days All but $630 a day $630 a day $0 Once lifetime reserve days are used: o Additional 365 days $0 100% of Medicare-eligible expenses o Beyond the additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital. First 20 days All approved amounts $0 $0 21st through 100th day All but $ a day $0 Up to $ a day 101st day and after $0 $0 All costs BLOOD First three pints $0 Three pints $0 Additional amounts 100% $0 $0 HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to receive these benefits. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0** $0 **NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. (continued) Page INDIVIDUAL
25 Plan A (continued) Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with a dagger), your Part B deductible will have been met for the calendar year. MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Part B excess charges (above Medicare-approved amounts) $0 $0 All costs BLOOD First three pints $0 All costs $0 Next $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 MEDICARE (PARTS A & B) SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0 Durable medical equipment First $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 Deductible amounts announced annually by CMS. Page INDIVIDUAL
26 Plan C * A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies. First 60 days All but $1,260 $1,260 (Part A deductible) $0 61st through 90th day All but $315 a day $315 a day $0 91st day and after: While using 60 lifetime reserve days All but $630 a day $630 a day $0 Once lifetime reserve days are used: o Additional 365 days $0 100% of Medicare-eligible expenses o Beyond the additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital. First 20 days All approved amounts $0 $0 21st through 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs BLOOD First three pints $0 Three pints $0 Additional amounts 100% $0 $0 HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to receive these benefits. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0** $0 **NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. (continued) Page INDIVIDUAL
27 Plan C (continued) Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with a dagger), your Part B deductible will have been met for the calendar year. MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Part B excess charges (above Medicare-approved amounts) $0 $0 All costs BLOOD First three pints $0 All costs $0 Next $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 MEDICARE (PARTS A & B) SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0 Durable medical equipment First $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts 80% 20% $0 OTHER BENEFITS NOT COVERED BY MEDICARE SERVICES MEDICARE PAYS PLAN PAYS YOU PAY FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum 20% and amounts over the of $50,000 $50,000 lifetime maximum Deductible amounts announced annually by CMS. Page INDIVIDUAL
28 Plan F *A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies. First 60 days All but $1,260 $1,260 (Part A deductible) $0 61st through 90th day All but $315 a day $315 a day $0 91st day and after: While using 60 lifetime reserve days All but $630 a day $630 a day $0 Once lifetime reserve days are used: o Additional 365 days $0 100% of Medicare-eligible expenses o Beyond the additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital. First 20 days All approved amounts $0 $0 21st through 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs BLOOD First three pints $0 Three pints $0 Additional amounts 100% $0 $0 HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to receive these benefits. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0** $0 **NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. (continued) Page INDIVIDUAL
29 Plan F (continued) Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with a dagger), your Part B deductible will have been met for the calendar year. MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Part B excess charges (above Medicare-approved amounts) $0 100% $0 BLOOD First three pints $0 All costs $0 Next $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 MEDICARE (PARTS A & B) SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0 Durable medical equipment First $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts 80% 20% $0 OTHER BENEFITS NOT COVERED BY MEDICARE SERVICES MEDICARE PAYS PLAN PAYS YOU PAY FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum 20% and amounts over the of $50,000 $50,000 lifetime maximum Deductible amounts announced annually by CMS. Page INDIVIDUAL
30 Plan N * A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies. First 60 days All but $1,260 $1,260 (Part A deductible) $0 61st through 90th day All but $315 a day $315 a day $0 91st day and after: While using 60 lifetime reserve days All but $630 a day $630 a day $0 Once lifetime reserve days are used: o Additional 365 days $0 100% of Medicare-eligible expenses o Beyond the additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicareapproved facility within 30 days after leaving the hospital. First 20 days All approved amounts $0 $0 21st through 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs BLOOD First three pints $0 Three pints $0 Additional amounts 100% $0 $0 HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to receive these benefits. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance **NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. (continued) $0** $0 Page INDIVIDUAL
31 Plan N (continued) Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with a dagger), your Part B deductible will have been met for the calendar year. MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Part B excess charges (above Medicare-approved amounts) $0 $0 All costs BLOOD First three pints $0 All costs $0 Next $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 Page INDIVIDUAL
32 Plan N (continued) Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with a dagger), your Part B deductible will have been met for the calendar year. MEDICARE (PARTS A & B) SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0 Durable medical equipment First $147 of Medicare-approved amounts $0 $0 $147 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 OTHER BENEFITS NOT COVERED BY MEDICARE SERVICES MEDICARE PAYS PLAN PAYS YOU PAY FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum 20% and amounts over the of $50,000 $50,000 lifetime maximum Deductible amounts announced annually by CMS. Page INDIVIDUAL
33 Questions? Need more information? Call one of our Medicare sales representatives at (TTY/TDD: 711) Seven days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voic . AmeriHealth Insurance Company of New Jersey AM6438 (10/14) Page INDIVIDUAL
34
35
MedigapSecurity Plan Information. Individual supplement plan options for people with Medicare. MedigapSecurity 5822(10/15)BKV1
2016 MedigapSecurity Plan Information Individual supplement plan options for people with Medicare MedigapSecurity 5822(10/15)BKV1 Thank you. We appreciate your interest in Independence Blue Cross. We
More informationBasic, including 100% Part B coinsurance. Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUECARE COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, F with High Deductible,
More informationBasic, including 100% Part B coinsurance. Foreign Travel Emergency
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, C, L and N
More informationSTONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N
STONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N These charts show the benefits included in each of the standard Medicare supplement plans.
More informationto $20 co-payment for office Basic, including 100% Part B Co-insurance, except up visit, and up to $50copayment Co-insurance Part A Deductible
STONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N These charts show the benefits included in each of the standard Medicare supplement plans.
More informationA B C D F F* G K L M N. Basic, including 100% Part B coinsurance. Basic, including 100% Part B coinsurance
Independence Blue Cross and Highmark Blue Shield Outline of Medicare Supplement Coverage MedigapSecurity Plans A, B, and C Benefit Chart of Medicare Supplement Plans sold on or After June 1, 2010 This
More informationBasic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility
AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included
More informationBasic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility
AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included
More informationPlan A Plan B Plan C Plan D Plan F F* Plan G Plan K Plan L Plan M Plan N. Hospitalization: 100%; other basic benefits paid at 50%
UNITED WORLD LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G, AND N This chart shows the benefits included in each of the standard Medicare
More informationTHE MANHATTAN LIFE INSURANCE COMPANY Outline of Medicare Supplement Coverage-Cover Page Benefit Plans A, C, F, G, AND N
THE MANHATTAN LIFE INSURANCE COMPANY Outline of Medicare Supplement Coverage-Cover Page Benefit Plans A, C, F, G, AND N These charts show the benefits included in each of the standard Medicare supplement
More informationA B C D F / F* G K L M N Basic including 100% Part B Coinsurance. Coinsurance. Coinsurance. Skilled Nursing Facility
This chart show the benefits included in each of the standard Medicare Supplement plans. Every insurer must make available Plan A. Some plans may not be available in your state. See Outlines of Coverage
More informationPlan A Plan B Plan C Plan D Plan F F* Plan G Plan K Plan L Plan M Plan N. Hospitalization: Skilled Nursing. 50% Skilled Nursing. Facility Coinsurance
Omaha Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of
More informationOutline of Medicare Supplement Coverage
Outline of Medicare Supplement Coverage Cover page 1 of 2 Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 Plans A, F, G, N These charts show the benefits included in each of the
More informationMedicare Supplement Outline of Coverage
Medicare Supplement Outline of Coverage Plans A, F & N Anthem Blue Cross and Blue Shield New Hampshire 2016 This booklet includes premium rates, Medicare deductibles, copays and maximum out-of-pocket costs.
More informationBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled
GOVERNMENT PERSONNEL MUTUAL LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G, AND N These charts show the benefits included in each of the standard Medicare
More informationSTONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G AND N
STONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G AND N These charts show the benefits included in each of the standard Medicare supplement
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
United World Life Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included
More informationIMPORTANT NOTICE PLEASE READ 2016 Medicare Cost-Sharing Amounts
IMPORTANT NOTICE PLEASE READ 2016 Medicare Cost-Sharing Amounts Dear Prospective Member: The Centers for Medicare & Medicaid Services (CMS) have not released the 2016 Medicare cost-sharing amounts as of
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
Omaha Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of the
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
Mutual of Omaha Insurance Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of the standard Medicare
More informationHospitalization and preventive care paid at 100%; other basic benefits paid at 50% Skilled Nursing. 50% Skilled Nursing. Facility Coinsurance
Omaha Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of the
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
Mutual of Omaha Insurance Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of the standard Medicare
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
United World Life Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
Mutual of Omaha Insurance Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included in each of the standard
More informationA B C D F F* G K L M N. Basic, including 100% Part B. coinsurance. at 50% Skilled Nursing Facility coinsurance Part A Deductible.
Shenandoah Life Insurance Company Administrative Office: P.O. Box 14558, Clearwater, FL 33766-4558 (855) 406-9085 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F, G and N Benefit
More informationA B C D F F* G K L M N. coinsurance. Skilled Nursing Facility. 75% Skilled Nursing Facility coinsurance 75% Part A Deductible.
Shenandoah Life Insurance Company Administrative Office: P.O. Box 14558, Clearwater, FL 33766-4558 (855) 406-9085 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F, G and N Benefit
More informationAPPLICATION FOR MEDICARE SUPPLEMENT INSURANCE INDIANA
HEARTLAND NATIONAL LIFE INSURANCE COMPANY Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE INDIANA HNAPP2010IN HEARTLAND
More informationUNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, B, C, D, F AND G
UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, B, C, D, F AND G These charts show the benefits included in each of
More informationbasic benefits paid at 50% 50% Skilled Nursing Facility Skilled Nursing 50% Part A Part A Deductible Part B Part B Excess (100%)
UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included
More informationto $20 co-payment for office visit, and up to $50 copayment Skilled B Co-insurance, except up Basic, including 100% Part Co-insurance Deductible
STONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N These charts show the benefits included in each of the standard Medicare supplement plans.
More informationcopayment for ER Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Part B 50% Part A
BANKERS FIDELITY LIFE INSURANCE COMPANY 4370 Peachtree Road, NE; PO Box 105185, Atlanta, GA 30348-5185 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates On or After 06-01-2010 This chart
More informationA B C D F F* G K L M N. coinsurance. Skilled Nursing Facility. 75% Skilled Nursing Facility coinsurance 75% Part A Deductible.
Shenandoah Life Insurance Company Administrative Office: P.O. Box 14558, Clearwater, FL 33766-4558 (855) 406-9085 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F, G and N Benefit
More informationA B C D F F* G K L M N. coinsurance. Skilled Nursing Facility. 75% Skilled Nursing Facility coinsurance 75% Part A Deductible.
Shenandoah Life Insurance Company Administrative Office: P.O. Box 14558, Clearwater, FL 33766-4558 (855) 406-9085 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F, G and N Benefit
More informationK L M N Basic, including 100% Part B. Basic, including 100% Part B Co- Insurance; other basic benefits paid at 50%
Companion Life Insurance Company Administrative Office PO Box 14158 Clearwater, Florida 33766-4158 (888) 220-0466 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, B, F and G - See Outlines
More informationThe Insurance Plans of Choice for Medicare Supplemental Coverage
The Insurance Plans of Choice for Medicare Supplemental Coverage Philadelphia American Life Insurance Company P.O. Box 4884 Houston, TX 77210-4884 POLICY FORM NUMBERS: MS.A.PAL.AR, MS.C.PAL.AR, MS.D.PAL.AR,
More informationBasic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part B Excess (100%) Foreign Travel Emergency
Texas OLD SURETY LIFE INSURANCE COMPANY ** 2016 ** ( effective 03/01/2016 ) Outline of Medicare Supplement Coverage Benefit Plans A and F Only are being offered by the company at this time. Benefit Plan
More informationBasic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.
More informationBasic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible
United of Omaha Life Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, HIGH DEDUCTIBLE F, G AND N This chart shows the benefits included
More informationBasic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.
More information2013 Outline of Medicare Supplement Coverage
Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box 659806, San Antonio, TX 78265-9106 Toll Free Telephone Number: 1-866-803-5169 Benefit Chart of Medicare Supplement Plans Sold for
More informationBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
ASSURED LIFE ASSOCIATION A Fraternal Benefit Society OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F AND G These charts show the benefits included in each of the standard
More informationOutline of Coverage. Medicare Supplement Insurance BENEFIT PLANS A,B,F, HIGH DEDUCTIBLE F, G, N. American Continental Insurance Company
American Continental Insurance Company 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 800 264.4000 aetnaseniorproducts.com Outline of Coverage Medicare Supplement Insurance BENEFIT S A,B,F, HIGH
More informationBasic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.
More informationBasic, including 100% Part B coinsurance
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE
More informationMedicare Supplement Outline of Coverage. Plans A, F, G & N Anthem Blue Cross and Blue Shield Missouri 2018
March 2, 2018 12:01 PM OOC18_MS_MO-T_DUAL-AFGN-AOOC001M(18)-MO-T_03-01-2018 Medicare Supplement Outline of Coverage Plans A, F, G & N Anthem Blue Cross and Blue Shield Missouri 2018 This booklet includes
More informationMutual of Omaha Application Packet
Mutual of Omaha Application Packet Thank you for your interest in applying for the Mutual of Omaha Medicare Supplement plan! This application packet provides you with a link to the Online Application to
More informationOutline of Coverage. Medicare Supplement Insurance BENEFIT PLANS A, B, F, G, N. AAA Medicare Supplement Plans
American Automobile Association (AAA) Medicare Supplement Insurance Office 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 855 663.2201 aetnaseniorproducts.com Outline of Coverage Medicare Supplement
More informationBlue Select Policy Comparison Chart Effective January 1, 2018 Blue Select Part A Hospital Insurance Covered Services
SERVICE MEDICARE PLAN A Hospitalization Semiprivate room and board. General nursing and miscellaneous hospital services and supplies. Network Hospital First 60 s Blue Select Policy Comparison Chart Part
More informationBasic, including 100% Part B coinsurance
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE
More informationBasic, including 100% Part B coinsurance
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE
More informationOmaha Insurance Company Application Packet
Omaha Insurance Company Application Packet Thank you for your interest in the Omaha Insurance Company Medicare Supplement plan! This application packet provides you with a link to the Online Application
More informationOmaha Insurance Company Application Packet
Omaha Insurance Company Application Packet Thank you for your interest in the Omaha Insurance Company Medicare Supplement plan! This application packet provides you with a link to the Online Application
More information2010 Medicare Supplement Insurance Plans
United of Omaha Life Insurance Company A Mutual of Omaha Company 2010 Medicare Supplement Insurance Plans Plans with coverage effective dates on and after June 1. Indiana U8183_IN_0010R UNITED OF OMAHA
More informationAetna Life Insurance Company Outline of Medicare Supplement Coverage
Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered To be eligible for coverage under an Individual Medicare Supplement you must be at least
More informationUnited of Omaha Application Packet
United of Omaha Application Packet Thank you for your interest in applying for the United of Omaha Medicare Supplement plan! This application packet provides you with a link to the Online Application to
More informationBlueCare Policy Comparison Chart Effective January 1, 2019 BlueCare Part A Hospital Insurance Covered Services
SERVICE MEDICARE PLAN A Hospitalization Semiprivate room and board. General nursing and miscellaneous hospital services and supplies. Network Hospital First 60 s BlueCare Policy Comparison Chart Part A
More informationBasic, including 100% Part B coinsurance. Basic, including. coinsurance. coinsurance* 50% Skilled Nursing Facility. Deductible
LOYAL AMERICAN LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G, and N This chart shows the benefits included in
More informationAmerican Continental Application Packet
American Continental Application Packet Thank you for your interest in applying for the American Continental/Aetna Medicare Supplement plan! This application packet provides you with access to a printable
More informationOUTLINE OF COVERAGE AND RATES FOR CONNECTICUT RESIDENTS
OUTLINE OF COVERAGE AND RATES FOR CONNECTICUT RESIDENTS Medicare Supplement benefit plans A, F, High-Deductible F, G, and N Cigna Medicare Supplement Insurance Cigna Health and Life Insurance Company CHLIC-HHD-OC.v2-CR-CT
More informationBasic, including 100% Part B coinsurance
Arkansas OLD SURETY LIFE INSURANCE COMPANY ** 2016 ** (effective 03/01/2016) Outline of Medicare Supplement Coverage Benefit Plans A, C and F Only are being offered by the company at this time. These charts
More informationOutline of Coverage. Medicare Supplement Insurance BENEFIT PLANS: A, B, F, G, & N. AAA Medicare Supplement Plans
American Automobile Association (AAA) Medicare Supplement Insurance Office 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 855 663.2201 aetnaseniorproducts.com Outline of Coverage Medicare Supplement
More informationBasic, including 100% Part B coinsurance, Except up to $ 20 copayment for office visit, and up to $ 50 copayment for ER Skilled Nursing
Kansas OLD SURETY LIFE INSURANCE COMPANY 2014 (effective 01/01/2014) Outline of Medicare Supplement Coverage Benefit Plans A and F Only are being offered by the company at this time. Benefit Plans A and
More informationBENEFIT PLANS A, B, F, G & N
American Automobile Association (AAA) Medicare Supplement Insurance Office 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 855 663.2201 aetnaseniorproducts.com Outline of Coverage Medicare Supplement
More informationA B C D F l F* G K L M N
Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010
More informationAetna Health & Life Application Packet
Aetna Health & Life Application Packet Thank you for your interest in applying for the Aetna Health & Life Medicare Supplement plan! This application packet provides you with access to a printable copy
More informationSTONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G AND N
STONEBRIDGE LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G AND N These charts show the benefits included in each of the standard Medicare supplement
More informationBasic, including 100% Part B coinsurance
BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE
More informationBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement
More informationRegence Bridge. Medicare Supplement (Medigap) Plans
OUTLINE OF COVERAGE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield
More informationBasic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. 50% Part A
BANKERS FIDELITY LIFE INSURANCE COMPANY 4370 Peachtree Road, NE; PO Box 105185, Atlanta, GA 30348-5185 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates On or After 06-01-2010 This chart
More informationOutline of Medicare Supplement Coverage
Tufts Medicare Preferred SUpplement PLANS 2014 Outline of Medicare Supplement Coverage Tufts Medicare Preferred Supplement Core Tufts Medicare Preferred Supplement One Effective January 1, 2014 December
More informationBasic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
GERBER LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE STANDARDIZED BENEFIT PLAN A AND SELECT BENEFIT PLANS F AND G This chart shows the benefits included in each of the standard
More informationBasic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.
More informationBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G, AND M These charts show the benefits included in each of the standard
More informationOUTLINE OF COVERAGE AND RATES FOR LOUISIANA RESIDENTS
OUTLINE OF COVERAGE AND RATES FOR LOUISIANA RESIDENTS Medicare Supplement benefit plans A, F, High-Deductible F, G, and N Cigna Medicare Supplement Insurance Cigna Health and Life Insurance Company CHLIC-HHD-OC-AA-LA
More informationOUTLINE OF COVERAGE AND RATES FOR TENNESSEE RESIDENTS
OUTLINE OF COVERAGE AND RATES FOR TENNESSEE RESIDENTS Medicare Supplement benefit plans A, F, High-Deductible F, G, and N Cigna Medicare Supplement Insurance Cigna Health and Life Insurance Company CHLIC-HHD-OC-AA-TN
More informationBasic, including 100% Part B Coinsurance. Part B. Deductible Part B. Deductible. Part B. Part B Excess (100%) Foreign Travel Emergency
A B C D F F G K L M N Basic, including Basic, including Part A Basic, including Skilled Part A Foreign Travel Emergency Basic, including Skilled Part A Foreign Travel Emergency Basic, including Skilled
More informationMedicare Supplement Coverage Options
A Division of HealthNow New York Inc. An Independent Licensee of the BlueCross BlueShield Association Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage
More informationOutline of Group Medicare Supplement Coverage
Outline of Group Medicare Supplement Coverage Effective January 1, 2018 301 S. Vine St., Urbana, IL 61801-3347 1-877-933-0028 TTY 711 HealthAlliance.org med-msgrpoutcov-11 med-msgrpoutcov18-1117 November
More informationK L M N # Basic, including 100% Part B co-insurance. Basic, including 100% Part B. co-insurance. Skilled Nursing Facility co-insurance.
Forethought Life Insurance Company Administrative Office P.O. Box 14659, Clearwater, FL 33766-4659 (877) 492-5870 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, C #, F #, G # and N
More informationBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for.
UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, G, and M These charts show the benefits included in each of
More informationOutline of Medicare Supplement Coverage Cover Page 1 of 2 Benefit Plans E and J
Outline of Supplement Coverage Cover Page 1 of 2 Benefit Plans E and J See Outlines of Coverage sections for details about ALL plans These charts show the benefits included in each of the standardized
More information2018 Outline of Coverage McLaren Medicare Supplement Plans A, C, F, High Deductible-F, G & N
2018 Outline of Coverage McLaren Medicare Supplement Plans A, C, F, High Deductible-F, G & N McLarenHealthPlan.com/MedicareSupplement Call us toll-free (888) 327-0671, Monday - Friday from 8 a.m. 6 p.m.
More informationGERBER LIFE INSURANCE COMPANY WHITE PLAINS, NEW YORK OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE
GERBER LIFE INSURANCE COMPANY WHITE PLAINS, NEW YORK OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BASIC AND EXTENDED BASIC PLANS The Commissioner of Insurance of the State of Minnesota has established
More informationOutline of Medicare Supplement Coverage
Outline of Medicare Supplement Coverage Effective April 1, 2016 301 S. Vine St., Urbana, IL 61801-3347 1-877-933-0028 TTY 711 HealthAllianceMedicare.org med-msoutcov-11 med-2010msoutcov-0616 April 2016
More information2019 Alliance Medicare Supplement Brochure
2019 Supplement Brochure MED SUPP 2019 PRODUCT BROCHURE Find the right plan for you. Supplement offers a choice of plans Plan A, Plan C, Plan F, Plan G and Plan N. The benefits of each of these plans are
More informationMutual of Omaha Application Packet
Mutual of Omaha Application Packet Thank you for your interest in applying for the Mutual of Omaha Medicare Supplement plan! This application packet provides you with a link to the Online Application to
More informationMED SUPP 2018 PROD BRO Alliance Medicare Supplement Brochure
MED SUPP 2018 PROD BRO 2018 Supplement Brochure Supplement helps f ill the gaps in Original. With Original, you are covered for many hospital and medical expenses, but there are some gaps in that coverage
More informationMedicare Supplement Outline of Coverage. Plans A, F, G & N. Amerigroup Insurance Company Arizona 2018
Medicare Supplement Outline of Coverage Plans A, F, G & N Amerigroup Insurance Company Arizona 2018 This booklet includes premium rates, Medicare deductibles, copays and maximum out-of-pocket costs. Call
More informationmore complete AARP MEDICARE SUPPLEMENT INSURANCE PLANS Insured by UnitedHealthcare Insurance Company 2017 Enrollment Materials
2017 Enrollment Materials more complete AARP MEDICARE SUPPLEMENT INSURANCE PLANS Insured by UnitedHealthcare Insurance Company These types of plans help with some of the out-of-pocket costs not paid by
More information2015 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N
Steve Shorr Insurance - Authorized Agent - 30.59.335 For more information and to very the latest details Anthem Blue Cross Administrative Office: P.O. Box 9063, Oxnard, CA 9303-9063 Toll Free Telephone
More informationSupplement. Medicare. Disclosure Packet. Included in this disclosure packet:
Americo Medicare Supplement Disclosure Packet Thank you for your interest in purchasing an Americo Financial Life and Annuity Insurance Company Medicare Supplement insurance policy. Below are the forms
More informationRegence Bridge Medicare Supplement (Medigap) Plans
IDAHO Regence Bridge Medicare Supplement (Medigap) Plans Overview Includes Senior Selection (Modified Plan F) Regence BlueShield of Idaho is an Independent Licensee of the BCBSA 06210rep06029-id Information
More informationPART A HOSPITAL SERVICES PER BENEFIT PERIOD SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION*
For Retirees of Orange County Board of County Commissioners Your Cigna Medicare Surround Group Medicare Supplement Insurance Plan N Effective Date: January 1, 2019 through December 31, 2019 Insured by
More informationSupplement. Medicare. Disclosure Packet. Included in this disclosure packet:
Americo Medicare Supplement Disclosure Packet Thank you for your interest in purchasing an Americo Financial Life and Annuity Insurance Company Medicare Supplement insurance policy. Below are the forms
More informationHomeTown Region. Medicare Select. Benefit Plan Summaries FORM # THP-39
HomeTown Region Select Benefit Plan Summaries FORM # THP-39 Outline of Select Coverage: Cover Page The Health Plan offers Benefit Plans A, C, D and F Supplement insurance can be sold in only ten standard
More informationMedicare Supplement Outline of Coverage
OOC_MS_CA-T_AFIBFGN_NTM (17)(Rev 09-2017)-201718rates September 27, 2017 1:39 PM Medicare Supplement Outline of Coverage s A, F, Innovative F, G & N Anthem Blue Cross California 2018 This booklet includes
More informationMedicare Supplement Outline of Coverage
Medicare Supplement Outline of Coverage Plans A, F & N Anthem Blue Cross California 2017 This booklet includes premium rates, Medicare deductibles, copays and maximum out-of-pocket costs. Call toll-free
More informationMedicare Supplement Outline of Coverage
Medicare Supplement Outline of Coverage Plans A, F, G & N Anthem Blue Cross and Blue Shield Colorado 2017 This booklet includes premium rates, Medicare deductibles, copays and maximum out-of-pocket costs.
More informationMedicare Supplement Outline of Coverage
OOC_MS_CO-T_NTM_AOOC001M(Rev 7-16)(09-19-2017)-2019rates 9/19/2018 10:52 AM (BASE/ORIG) Medicare Supplement Outline of Coverage Plans A, F, G & N Anthem Blue Cross and Blue Shield Colorado 2019 This booklet
More information