Magellan Rx Medicare Basic (PDP) Summary of Benefits
|
|
|
- Abigail Black
- 6 years ago
- Views:
Transcription
1 2018 Magellan Rx Medicare Basic (PDP) Summary of Benefits January 1, 2018 December 31, 2018 This Summary of Benefits booklet gives you a summary of what Magellan Rx Medicare Basic (PDP) covers and what you pay. It doesn t list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage. It is available online at medicare.magellanrx.com or you may call Customer Service at (TTY: 711) to request a copy. How to use this book You can use the information in this booklet to learn about the Magellan Rx Medicare Basic (PDP) plan or to compare our plan with other Medicare health plans to find which is best for you. If you want to know more about the coverage and costs of Original Medicare, look in your current Medicare & You handbook. View it online at or get a copy by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call S4607_SUMBENI2018R8 Accepted
2 Things to Know About Magellan Rx Medicare Basic (PDP) Who can join? To join Magellan Rx Medicare Basic (PDP), you must be entitled to Medicare Part A, and/or be enrolled in Medicare Part B, and live in our service area. Our service area includes the following: North Carolina Which drugs are covered? You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website ( magellanrx.com). Or, call us and we will send you a copy of the formulary. 2 Summary of Benefits
3 How will I determine my drug costs? Our plan groups each medication into one of five tiers. You will need to use your formulary to locate what tier your drug is on to determine how much it will cost you. The amount you pay depends on the drug s tier and what stage of the benefit you have reached. Later in this document we discuss the benefit stages that occur after you meet your deductible: Initial Coverage, Coverage Gap, and Catastrophic Coverage. Which pharmacies can I use? We have a network of pharmacies and you must generally use these pharmacies to fill your prescriptions for covered Part D drugs. Some of our network pharmacies have preferred cost-sharing. You may pay less if you use these pharmacies. Our website can help you find a pharmacy in your neighborhood or wherever you may travel. To see network pharmacies in our plan, visit our website ( com). Or, call us and we will send you a copy of the pharmacy directory. Summary of Benefits 3
4 Monthly Premium and Prescription Drug Benefits Initial Coverage Cost-Sharing may change depending on the pharmacy you choose and when you enter another phase of the Part D benefit. For more information on the additional pharmacy-specific costsharing and the phases of the benefit, please call us or access our Evidence of Coverage on our website. You may get your drugs at network retail pharmacies and mail order pharmacies. If you reside in a long-term care facility, you pay the same copayment/coinsurance as at a standard retail pharmacy. You may get drugs from an out-of-network pharmacy, but may pay more than you pay at an in-network pharmacy. Coverage Gap Most Medicare drug plans have a coverage gap (also called the donut hole ). This means that there s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,750. After you enter the coverage gap, you pay 35% of the negotiated price and a portion of the dispensing fee for brand name drugs, and 44% of the price for generic drugs until your costs total $5,000, which is the end of the coverage gap. Not everyone will enter the coverage gap. Catastrophic Coverage After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,000, you pay the greater of: 5% of the cost, or $3.35 copayment for generic (including brand drugs treated as generic) and a $8.35 copayment for all other drugs 4 Summary of Benefits
5 Plan Premium and Deductible What you should know Monthly Premium $63.60 per month You must continue to pay your Medicare Part B premium. Yearly Deductible $405 per year for Part D prescription drugs After you pay your yearly deductible, you pay the following (see below) until your total yearly drug costs reach $3,750. Total yearly drug costs are the total drug costs paid by both you and our Part D plan. Copayment / Coinsurance By Tier Tiers One-Month Supply Three-Month Supply Standard Retail or Long-Term Care Cost-Sharing Preferred Retail or Mail Order Cost-Sharing Standard Retail or Long-Term Care Cost-Sharing Preferred Retail or Mail Order Cost-Sharing Tier 1 (Preferred Generic) Tier 2 (Generic) Tier 3 (Preferred Brand) Tier 4 (Non-Preferred Drug) Tier 5 (Specialty Tier) $8 $1 $24 $3 $11 $4 $33 $12 15% 15% 15% 15% 50% 50% 50% 50% 25% 25% - - Summary of Benefits 5
6 6 Summary of Benefits
7 Magellan Rx Medicare Basic (PDP) Phone Numbers and Website 24/7 Magellan Rx Medicare Basic (PDP) Customer Service TTY users call
8 Discrimination is against the law Magellan* follows the law. We treat all people equally. We do not discriminate against anyone based on: Race. Color. National origin. Age. Disability. Sex. We provide free help and services to people with disabilities. We want you to be able to communicate with us easily. We offer: Qualified sign language interpreters. Written information in many formats. These may include: Large print. Audio. Accessible electronic formats. Other formats. We also provide free language services to people whose first language is not English. We offer: Qualified interpreters. Information that is written in other languages. Contact us at if you need any of these services. If you believe we have not provided these services or discriminated in another way, you can file a grievance with: Civil Rights Coordinator, Corporate Compliance Department 6950 Columbia Gateway Drive Columbia MD Fax: compliance@magellanhealth.com * Magellan refers to all applicable subsidiaries and affiliates of Magellan Health, Inc. including but not limited to Magellan Healthcare, Inc., National Imaging Associates, Inc., Magellan Rx Management, LLC and Magellan Complete Care. 8 Summary of Benefits
9 You can file a grievance in one of three ways. By mail. By fax. By . The civil rights coordinator is available if you need help with any of this. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You may do this online at Or you may do this by mail or phone. U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C TDD: Complaint forms are available online. You may find them at index.html. Summary of Benefits 9
10 ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia linguística. Llame al (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY:711) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). ملحوظة: إذا كنت تتحدث اذكر اللغة فا ن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم (رقم ھاتف الصم والبكم: 117). ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (ATS : 711). UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: 711). PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711). ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: 711). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: 711). خبردار: اگر آپ اردو بولتے ہیں تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں کال کریں (TTY: 711). ল ক ন য দ আপ ন ব ল, কথ বল ত প রন, ত হ ল ন খরচ য় ভ ষ সহ য়ত প র ষব উপল আ ছ ফ ন ক ন (TTY:711) אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. רופט (TTY: 711) 10 Summary of Benefits
11 Magellan Rx Medicare Basic (PDP) is a stand-alone prescription drug plan with a Medicare contract. Enrollment in Magellan Rx Medicare Basic (PDP) 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. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary and pharmacy network may change at any time. You will receive notice when necessary. Medicare beneficiaries may also enroll in Magellan Rx Medicare Basic (PDP) through the CMS Medicare Online Enrollment Center located at Magellan Rx Medicare Basic (PDP) s pharmacy network offers limited access to pharmacies with preferred cost-sharing in the following states within our service area: North Carolina. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost-sharing, please call Customer Service at (TTY: 711) or consult the online pharmacy directory at This document is available in other formats such as Braille and large print. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia linguística. Llame al (TTY: 711). Summary of Benefits 11
12 Magellan Health, Inc.
PO Box 1037 New York, NY <Date> <Barcode><Letter Code> <Name> <Address> <City>, <State> <Zip> Dear <Dual Advantage Member>:
PO Box 1037 New York, NY 10268-1037 1-800-514-4912 , Dear : This mailing is letting you know about an important
2018 Simply Prescriptions Employer/Union Group Medicare Prescription Drug Plan Enrollment Form
2018 Simply Prescriptions Employer/Union Group Medicare Prescription Drug Plan Enrollment Form A Division of Excellus Health Plan Simply Prescriptions P.O. Box 546 Buffalo, NY 14201-0546 B-3688Y18 Please
2018 Medicare Blue Choice (HMO-POS) and Medicare Blue PPO Employer/Union Group Health Plan Enrollment Request Form
2018 Medicare Blue Choice (HMO-POS) and Medicare Blue PPO Employer/Union Group Health Plan Enrollment Request Form Attn: Medicare Division Excellus BlueCross BlueShield P.O. Box 546 Buffalo, NY 14201-0546
NY Large Group (101+ Full-Time Equivalent Employees)
NY Large Group (101+ Full-Time Equivalent Employees) The following underwriting requirements apply to all large group new business applications and renewals of coverage on our license. A. Group Size Requirements
NY Individual Coverage
NY Individual Coverage The following underwriting requirements apply to all individual new business applications and renewals of coverage on the license. OFF EXCHANGE Requirements To be eligible for individual
Dear Health First Health Plans Member:
Dear Health First Health Plans Member: You are enrolled in a Medicare Advantage plan offered by Health First Health Plans. A snapshot of the 2017 plans can be found on the first page of the attached form.
This is a summary of drug and health services covered by Florida Hospital Care Advantage effective January 1, 2019
This is a summary of drug and health services covered by Florida Hospital Care Advantage effective January 1, 2019 Benefits Monthly Plan Premium In addition, you must keep paying your Medicare Part B premium.
Abbreviated Enrollment Application for Current Members
2017 MEDICARE ADVANTAGE Abbreviated Enrollment Application for Current Members Senior Blue (HMO or HMO-POS) Forever Blue Medicare (PPO) Optional Supplemental Dental! If you are changing plans within Senior
2018 Medicare Blue Choice (HMO) and (HMO-POS) Individual Enrollment Request Form
2018 Medicare Blue Choice (HMO) and (HMO-POS) Individual Enrollment Request Form Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan with a Medicare contract. Enrollment
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax:
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: 7050 S Union Park Center Drive Suite 200 Midvale, Utah 84047 Fax Number: (866) 290-1309
Enrollment Application
2017 MEDICARE ADVANTAGE Enrollment Application Senior Blue (HMO) Forever Blue Medicare (PPO) Optional Supplemental Dental If you have any questions, we re here to help! bcbswny.com/medicare 1-800-248-9296
GROUP HMO & PPO PLANS MEMBER APPLICATION
CDPHP Medicare Choices GROUP HMO & PPO PLANS MEMBER APPLICATION APPLICANT: Please print and use ink. If you have questions about benefits, pharmacy, or the CDPHP provider network, call CDPHP member services
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
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.bcbswny.com or by calling 1-888-249-2583. Important Questions
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, Medicare Bassett (HMO-POS) (H )
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 Medicare Bassett (HMO-POS) (H3351-015) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
Catastrophic Coverage Period: 01/01/ /31/2017
Catastrophic Coverage Period: 01/01/2017-12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Spouse, Family Plan Type: EPO This is only a summary.
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, Medicare BlueBasic (PPO)(H ) and Medicare BluePlus (PPO)(H )
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 Medicare BlueBasic (PPO)(H3335-044) and Medicare BluePlus (PPO)(H3335-018) This is a summary of drug and health services covered by Excellus BlueCross
Standard Gold Coverage Period: 01/01/ /31/2017
Standard Gold Coverage Period: 01/01/2017-12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Spouse, Family Plan Type: EPO This is only a summary.
Request for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because Horizon Blue Cross Blue Shield of New Jersey denied your request for coverage of (or payment for) a prescription drug, you have
2018 Excellus BlueCross BlueShield Medicare PPO Individual Enrollment Request Form
2018 Excellus BlueCross BlueShield Medicare PPO Individual Enrollment Request Form Excellus BlueCross BlueShield contracts with the Federal Government and is a PPO plan with a Medicare contract. Enrollment
YOUR DRUG IS NOT ON OUR LIST OF COVERED DRUGS (FORMULARY) OR IS SUBJECT TO CERTAIN LIMITS
6323 Seventh Avenue Brooklyn, NY 11220 Dear : YOUR DRUG IS NOT ON OUR LIST OF COVERED DRUGS (FORMULARY) OR IS SUBJECT TO CERTAIN
Follow these easy steps to enroll in a TexanPlus Health Maintenance Organization.
TexanPlus HMO City of Houston 2017 Enrollment Form Follow these easy steps to enroll in a TexanPlus Health Maintenance Organization. 1. Each applicant must fill out a separate enrollment form. 2. Have
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 (H3335-054), (H3335-051) and (H3335-005) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
2018 Excellus BlueCross BlueShield Medicare PPO and HMO Individual Enrollment Request Form
2018 Excellus BlueCross BlueShield Medicare PPO and HMO Individual Enrollment Request Form Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan and PPO plan with a Medicare
AMENDMENT NUMBER 1 TO TEAMSTERS LOCAL 294- ALBANY AREA TRUCKING AND ALLIED INDUSTRIES HEALTH & WELFARE FUND HEALTH REIMBURSEMENT ARRANGEMENT
AMENDMENT NUMBER 1 TO TEAMSTERS LOCAL 294- ALBANY AREA TRUCKING AND ALLIED INDUSTRIES HEALTH & WELFARE FUND HEALTH REIMBURSEMENT ARRANGEMENT The Teamsters Local 294- Albany Area Trucking and Allied Industries
Benefits Group Plus A (HMO) Group Plus B (HMO) Group (HMO-POS) Monthly Plan Premium In addition, you must keep paying your Medicare Part B
Medicare Advantage (Employer Group Plans) This is a summary of drug and health services covered by Health First Health Plans effective January 1, 2019 Monthly Plan Premium In addition, you must keep paying
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, Medicare Bassett (HMO-POS) (H )
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, 2019 Medicare Bassett (HMO-POS) (H3351-015) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
Medicare Advantage This is a summary of drug and health services covered by Health First Health Plans effective January 1, 2019
Medicare Advantage This is a summary of drug and health services covered by Health First Health Plans effective January 1, 2019 Benefits Monthly Plan Premium In addition, you must keep paying your Medicare
You can see the specialist you choose without permission from this plan.
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.bcbswny.com or by calling 1-855-344-3425. Important Questions
2019 SUMMARY OF BENEFITS
2019 SUMMARY OF BENEFITS Vitality Health Plan of California (HMO) County and County H1426 001/002/003 H1426_19_078_MK_ENG_M H1426 001/002/003 Vitality Health Plan of California January 1, 2019 December
You don t have to meet deductibles for specific services, but see the chart starting on page 3 for other costs for services this plan covers.
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.bcbswny.com or by calling 1-855-344-3425. Important Questions
SUMMARY OF BENEFITS EFFECTIVE JANUARY 1, DECEMBER 31, 2018 AFFINITY MEDICARE. Passport Essentials (HMO) Passport Essentials NYC (HMO)
SUMMARY OF 20 18 BENEFITS EFFECTIVE JANUARY 1, 2018 - DECEMBER 31, 2018 AFFINITY MEDICARE Essentials (HMO) Essentials NYC (HMO) This is a summary of drug and health services covered by Affinity Medicare
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, Medicare BlueEnhanced (PPO) (H ) and Medicare BlueBasic (PPO) (H )
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 (H3335-015) and Medicare BlueBasic (H3335-043) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, Medicare BlueBasic (PPO)(H ) Medicare BluePlus (PPO)(H )
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, 2019 (H3335-044) Medicare BluePlus (H3335-018) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
TRS-CARE. enrollment guide. for Non-Medicare Eligible Retirees. Plan Year: Sept. 1, 2016 Dec. 31, TRScarestandardaetna.com
TRS-CARE enrollment guide for Non-Medicare Eligible Retirees Plan Year: Sept. 1, 2016 Dec. 31, 2017 TRScarestandardaetna.com This guide provides an overview of the TRS-Care eligibility requirements, enrollment,
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018
2018 SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 (H3335-053), (H3335-038) and (H3335-014) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
Summary of Benefits. Allwell Medicare Premier (HMO) Osceola County, Florida H
2018 Summary of Benefits Osceola County, Florida H9276-009 Benefits effective January 1, 2018 H9276_18_2870SB_Accepted 09072017 This booklet provides you with a summary of what we cover and your cost-sharing.
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, 2019
2019 SUMMARY OF BENEFITS January 1, 2019 December 31, 2019 (H3351-018) (H3351-016), (H3351-011) This is a summary of drug and health services covered by Excellus BlueCross BlueShield. Excellus BlueCross
2017 Enrollment Request Form
2017 Enrollment Request Form Please contact Health First Health Plans if you need information in another language or format (Braille). To Enroll in Health First Health Plans, Please Provide the Following
2017 Medicare Blue PPO Group Health Plan Enrollment Request Form
2017 Medicare Blue PPO Group Health Plan Enrollment Request Form Return Applications to: Department of Human Resources Rochester Institute of Technology George Eastman Hall, 5th floor 8 Lomb Memorial Drive
Annual Notice of Changes for 2018
A nonprofit independent licensee of the Blue Cross Blue Shield Association Medicare BlueBasic (PPO) offered by Excellus BlueCross BlueShield Annual Notice of Changes for 2018 You are currently enrolled
Annual Notice of Changes for 2018
A nonprofit independent licensee of the Blue Cross Blue Shield Association Medicare Blue Choice Optimum (HMO-POS) offered by Excellus BlueCross BlueShield Annual Notice of Changes for 2018 You are currently
2019 Qualified Health Plan (QHP) transparency reporting for Individual HMO
2019 Qualified Health Plan (QHP) transparency reporting for Individual HMO Information on Explanation of Benefits (EOB) Your EOB is a statement that shows what health services you received, what bills
Summary of Material Modifications 11/1/2018 SUMMARY OF MATERIAL MODIFICATIONS PLAN BENEFIT CHANGES TO: All Covered Plan Participants
11/1/2018 SUMMARY OF MATERIAL MODIFICATIONS TO: All Covered Plan Participants FROM: The Writers Guild- Industry Health Fund This document is a Summary of (SMM), intended to notify you of changes to your
Welcome to Cigna Vision Schedule of Vision Coverage
Summary of Benefits Cigna Health and Life Insurance Company Cigna Vision Arlington County Government Welcome to Cigna Vision Schedule of Vision Coverage Coverage In-Network Benefit Out-of-Network Benefit
Medicare Blue Choice Select (HMO) offered by Excellus BlueCross BlueShield
A nonprofit independent licensee of the Blue Cross Blue Shield Association Medicare Blue Choice Select (HMO) offered by Excellus BlueCross BlueShield Annual Notice of Changes for 2019 You are currently
2017 Summary of Benefits
2017 Summary of Benefits Select Counties in Houston-Beaumont Area: Houston: Austin, Brazoria, Fort Bend, Galveston (zip codes: 77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77565, 77568, 77573,
COBRA CONTINUATION COVERAGE ELECTION FORM
Instructions: To elect COBRA continuation coverage, complete this Election Form and return it to us. Under federal law, you have 60 days after the date of this notice to decide whether you want to elect
Annual Notice of Changes for 2018
Mercy Care Advantage (HMO SNP) offered by Southwest Catholic Health Network Annual Notice of Changes for 2018 You are currently enrolled as a member of Mercy Care Advantage. Next year, there will be some
Elderplan Plus Long Term Care (HMO SNP) offered Elderplan, Inc. Annual Notice of Changes for 2018
Elderplan Plus Long Term Care (HMO SNP) offered Elderplan, Inc. Annual Notice of Changes for 2018 You are currently enrolled as a member of Elderplan Plus Long Term Care (HMO SNP). Next year, there will
Annual Notice of Changes for 2018
A nonprofit independent licensee of the Blue Cross Blue Shield Association Medicare BlueEnhanced (PPO) offered by Excellus BlueCross BlueShield Annual Notice of Changes for 2018 You are currently enrolled
IMPORTANT NOTICE: Your Medicare plan won t be offered in 2018
IMPORTANT NOTICE: Your Medicare plan won t be offered in 2018 Keep this letter. It s proof that you have a special right to buy a Medigap policy
Cigna Health and Life Insurance Company. Welcome to Cigna Vision Schedule of Vision Coverage. Benefit
Summary of Benefits Cigna Health and Life Insurance Company Cigna Vision UT Graduate Medical Education Program - Vision Welcome to Cigna Vision Schedule of Vision Coverage Coverage In-Network Benefit Out-of-Network
2018 Summary of Benefits
Medicare GenerationRx (Employer PDP) 2018 Summary of Benefits January 1, 2018 - December 31, 2018 S9579 For the NEA Group Part D Program Advanced Plan 2 This is a summary of prescription drug services
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2019 Plan Type: HMO.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Coverage for: Single/Family Plan Type: HMO. The Summary of Benefits and
Elderplan Advantage for Nursing Home Residents (HMO SNP) offered by Elderplan, Inc.
(HMO SNP) offered by Elderplan, Inc. Annual Notice of Changes for 2019 You are currently enrolled as a member of Elderplan Advantage for Nursing Home Residents (HMO SNP). Next year, there will be some
SBOSB015. Summary of Benefits. Humana Preferred Rx Plan (PDP) State of Missouri
SBOSB015 2017 Summary of Benefits Humana Preferred Rx Plan (PDP) State of Missouri GNHH4HIEN_17 S5884140000SB17 201 7 Summary of Benefits Humana Preferred Rx Plan (PDP) S5884-140 State of Missouri S5884_SB_PDP_PDP_140000_2017
Annual Notice of Changes for 2017
Classic Plan (HMO-POS) offered by Health First Health Plans Annual Notice of Changes for 2017 You are currently enrolled as a member of the Classic Plan (HMO-POS). Next year, there will be some changes
Coverage for: Individual, Individual + Family Plan Type: HMO
Summary of Benefits and Coverage: What this plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 CHRISTUS Health Plan: New Mexico Silver Low-Deductible Limited CS Coverage
$0 at IHCP or with IHCP referral at non-ihcp; $2,400/individual or $4,800/family. Doesn t apply to Preventive care.
Summary of Benefits and Coverage: What this plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 CHRISTUS Health Plan: New Mexico American Indian Gold Statewide Limited
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2018 Plan Type: HMO.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 Coverage for: Single/Family Plan Type: HMO. The Summary of Benefits and
See the Common Medical Events below for your costs for services this plan. What is the overall deductible? covers.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Health & Benefit Trust Fund of the IUOE Local 94-94A-94B Fund Coverage Period: 01/01/2019 12/31/2019 School Division:
NY MVP Premier Plus HDHP Silver 3
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Coverage for: Single/Family Plan Type: HDHP. The Summary of Benefits and
In Network: $350 Individual/ $700 Family Out-of-Network: $500 Individual/ $1,000 Family
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Carnegie Mellon University PPO Option 2, PPO - Premium Network: UPMC Health
MEDICARE. Go365 Mall Catalog MAKE HEALTHIER CHOICES
MAKE HEALTHIER CHOICES MEDICARE Go365 Mall Catalog With Go365 by Humana, you re on the path to achieving a healthier lifestyle for you and the people you love. You re also on the way to earning Go365 Bucks,
Summary of Benefits. Humana Preferred Rx Plan (PDP) State of North Carolina. Our service area includes the following state(s): North Carolina.
SBOSB026 2018 Summary of Benefits Humana Preferred Rx Plan (PDP) State of North Carolina Our service area includes the following state(s): North Carolina. GNHH4HIEN_18 S5884133000SB18 2018 Summary of
2019 Summary of Benefits
Tamarra D. PHP Care Coordinator 2019 Summary of H3132 Broward, Duval and Miami-Dade Counties January 1, 2019 December 31, 2019 is Medicare Advantage HMO plan with a Medicare contract. Enrollment in PHP
Annual Notice of Changes for 2018 for the NEA Group Part D Program Advanced Plan
Medicare GenerationRx (Employer PDP) offered by Transamerica Life Insurance Company Annual Notice of Changes for 2018 for the NEA Group Part D Program Advanced Plan You are currently enrolled as a member
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.thehealthplan.com or by calling 1-866-379-4489. Important
Gym Access IND Bronze HMO 1340 Health Benefit Plan Q3A
Schedule of Benefits for Covered Services In-Network Out-of-Network Financial Features Medical Essential Health Benefits Deductible (DED 1 ) (PBP 2 ) $7,900 per person N/A (DED is the amount the member
2019 SUMMARY OF BENEFITS
2019 SUMMARY OF BENEFITS Overview of your plan AARP MedicareRx Saver Plus (PDP) S5921-353 Look inside to learn more about the drug coverages the plan provides. Call Customer Servi or go online for more
NAVITUS MEDICARERX (PDP) SUMMARY OF BENEFITS Carmel Central School District
Share a Clear View medicarerx (PDP) NAVITUS MEDICARERX (PDP) SUMMARY OF BENEFITS 2018 Carmel Central School District The Navitus MedicareRx Prescription Drug Plan (PDP) for the Carmel Central School District
2017 Summary of Benefits
2017 Summary of Benefits Select Counties in Maine and New York: Maine: Cumberland and Sagadahoc. New York: Albany, Allegany, Broome, Cayuga, Chemung, Chenango, Cortland, Erie, Fulton, Genesee, Herkimer,
BENEFITS EFFECTIVE JANUARY 1, DECEMBER 31, 2019
SUMMARY OF BENEFITS EFFECTIVE JANUARY 1, 2019 - DECEMBER 31, 2019 2019 AFFINITY MEDICARE Essentials (HMO) Essentials NYC (HMO) AffinityMedicarePlan.org 1 This is a summary of drug and health benefits
2017 MEMBER HANDBOOK: YOUR EVIDENCE OF COVERAGE. VNSNY CHOICE Medicare. VNSNY CHOICE Medicare Preferred (HMO SNP)
A Medicare Advantage and Medicaid Advantage Program 2017 MEMBER HANDBOOK: YOUR EVIDENCE OF COVERAGE VNSNY CHOICE Medicare VNSNY CHOICE Medicare Preferred (HMO SNP) H5549_Preferred 2017 ANOCEOCv2 Accepted
2017 Medicare Blue Choice (HMO) and (HMO-POS) Individual Enrollment Request Form
2017 Medicare Blue Choice (HMO) and (HMO-POS) Individual Enrollment Request Form Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan with a Medicare contract. Enrollment
Accenture Leadership United States Benefit Plans Summary Plan Description
Accenture Leadership United States Benefit Plans Summary Plan Description (Effective January 1, 2017) TABLE OF CONTENTS INTRODUCTION 1 BECOMING ACCENTURE LEADERSHIP 1 VOLUNTARY COVERAGE 1 Choices 1 Life
Summary of Benefits and Coverage:
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Health & Benefit Trust Fund of the IUOE Local 94-94A-94B Fund Coverage Period: 01/01/2019 12/31/2019 Commercial
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/ /30/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2018-06/30/2019 Panther Gold Advantage: UPMC Health Plan Coverage for: All coverage levels
Medicare and Medicare-Medicaid Plans Prescription Claim Form
Medicare and Medicare-Medicaid Plans Prescription Claim Form You can use this form to ask us to pay for our share of your covered drugs. Check your Evidence of Coverage or Member Handbook for more information.
New York Small Group (1-100 Full-Time Equivalent Employees)
New York Small Group (1-100 Full-Time Equivalent Employees) The following underwriting requirements apply to all small group new business applications and renewals of coverage on our license. A. Group
2017 Summary of Benefits. Peach State Health Plan Medicare Advantage (HMO) DeKalb and Fulton Counties H7173, Plan 002
2017 Summary of Benefits Peach State Health Plan Medicare Advantage (HMO) DeKalb and Fulton Counties H7173, Plan 002 H7173-002_2017_SB_Accepted_09062016 Summary of Benefits January 1, 2017 December 31,
SUMMARY OF BENEFITS. Illinois. Fresenius Total Health (HMO SNP)
SUMMARY OF BENEFITS Illinois Fresenius Total Health (HMO SNP) H1343_FSB18 Accepted 08/15/2017 2018 ALL OF YOUR COVERAGE under one roof Hospital Medical Part A Rx Part B Bonus Part D If dialysis is a part
HEALTH INSURANCE MARKETPLACE BAD THINGS HAPPEN.
HEALTH INSURANCE MARKETPLACE BAD THINGS HAPPEN. GOOD THING THERE S PARAMOUNT. PIC-HIX-BROCHURE2019 THE AFFORDABLE CARE ACT AND PARAMOUNT. By now, you re probably familiar with the Affordable Care Act (ACA).
HEALTH INSURANCE MARKETPLACE BAD THINGS HAPPEN.
HEALTH INSURANCE MARKETPLACE BAD THINGS HAPPEN. GOOD THING THERE S PARAMOUNT. Earn $25 for completing your HRA. Details on page 3. PIC-HIX-BROCHURE2018 THE AFFORDABLE CARE ACT AND PARAMOUNT. By now, you
Summary of Benefits. Allwell Medicare Premier (HMO) Broward County, Florida H
2018 Summary of Benefits Broward County, Florida H9276-013 Benefits effective January 1, 2018 H9276_18_2781SB_A_Accepted 09172017 1 This booklet provides you with a summary of what we cover and your cost-sharing.
2017 Summary of Benefits. Trillium Advantage TLC ISNP (HMO SNP) Lane County H2174, Plan 003
2017 Summary of Benefits Trillium Advantage TLC ISNP (HMO SNP) Lane County H2174, Plan 003 H2174-003_2017_SB_Accepted_09082016 Summary of Benefits January 1, 2017 December 31, 2017 This is a summary of
2018 Summary of Benefits
2018 Summary of Benefits Bronx, Kings (Brooklyn), Queens, Nassau, New York (Manhattan), Suffolk and Westchester Counties LiveWell (HMO) If you remember these special moments, you re ready for AgeWell New
2017 Summary of Benefits. Peach State Health Plan Medicare Advantage (HMO) Chattahoochee, Harris, and Muscogee Counties H7173, Plan 003
2017 Summary of Benefits Peach State Health Plan Medicare Advantage (HMO) Chattahoochee, Harris, and Muscogee Counties H7173, Plan 003 H7173-003_2017_SB_Accepted_09062016 Summary of Benefits January 1,
2017 Summary of Benefits
2017 Summary of Benefits Sunshine Health Medicare Advantage (HMO) Duval County H9276, Plan 001 H9276-001_2017_SB_Accepted_09062016 Summary of Benefits January 1, 2017 December 31, 2017 This is a summary
2017 Summary of Benefits. Superior HealthPlan Medicare Advantage (HMO) Collin, Dallas, Denton and Smith Counties H0062, Plan 002
2017 Summary of Benefits Superior HealthPlan Medicare Advantage (HMO) Collin, Dallas, Denton and Smith Counties H0062, Plan 002 H0062-002_2017_SB_Accepted_09062016 Summary of Benefits January 1, 2017 December
2017 Summary of Benefits
2017 Summary of Benefits Sunshine Health Medicare Advantage (HMO) Pasco, Pinellas and Polk Counties H9276, Plan 002 H9276-002_2017_SB_Accepted_09062016 Summary of Benefits January 1, 2017 December 31,
2019 SUMMARY OF BENEFITS
2019 SUMMARY OF BENEFITS Overview of your plan AARP MedicareRx Preferred (PDP) S5820-024 Look inside to learn more about the drug coverages the plan provides. Call Customer Servi or go online for more
Introduction to the Health Options Online Payment System. October 2016
Introduction to the Health Options Online Payment System October 2016 NON-DISCRIMINATION NOTICE Community Health Options does not view or treat people differently because of their race, color, national
Geisinger Quality Options: Silver Plan
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning on or after 01/01/2017 Geisinger Quality Options: Silver Plan Coverage for: All coverage
Summary Of Benefits January 1, December 31, 2019
Summary Of Benefits January 1, 2019 - December 31, 2019 Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association Care1st is an independent licensee of the
UCare for Seniors (HMO-POS) Short Enrollment Request Form
UCare for Seniors (HMO-POS) Short Enrollment Request Form Name of plan you are enrolling in: Name: Member or Medicare number: Home phone number: Permanent street address (P.O. Box not allowed): City: State:
Annual Notice of Changes for 2017
SunSaver Plan (HMO-POS) offered by Health First Health Plans Annual Notice of Changes for 2017 You are currently enrolled as a member of the SunSaver Plan (HMO-POS). Next year, there will be some changes
2019 SUMMARY OF BENEFITS
2019 SUMMARY OF BENEFITS Overview of your plan AARP MedicareRx Walgreens (PDP) S5921-390 Look inside to learn more about the drug coverages the plan provides. Call Customer Servi or go online for more
Coverage for: Individual +Family Plan Type: PPO
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Greater Clark County Schools Corporation: PPO Plan Coverage for: Individual
This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, call.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Plan Type: This is only a summary. For more information about your coverage, or to get a copy of