Medvantage Plan with Optional Point of Service Benefit
(No Part D Prescription Benefit) 2010

Questions:

If you have questions or require assistance, please call:
FHCP’s Marketing Department at 1-800-232-0578, TTY users please call TTY: TRS Relay 711, Hours of Operation:

  • November 15 through March 1 from 8 am to 8 pm – 7 days a week
  • March 2 through November 14 from 8 am to 8 pm - Monday through Friday Only.

Enroll on-line today!

Benefits at a glance:

Premium and Other Important Information
Monthly Plan Premium $37.00 (See Optional Point of Service Details)
Medical Annual Deductible In- or Out-of-Network: $0
Medical Out-of-Pocket Maximum

In-Network: $0

Out-of-Network: $0
You must continue to pay your Medicare Part B premium.
Physician Services
Doctor Choice You may go to any provider that accepts Medicare assignment or utilize our HMO Provider Network, without a referral.
Specialist Referral Required No referral required
Primary Care Provider Office Visit

In-Network: $10 copay per office visit

Out-of-Network: 20% coinsurance
Specialist Office Visit

In-Network: $35 copay per office visit

Out-of-Network: 20% coinsurance
Hospital/Pharmacy Service
Inpatient Hospital Care

In-Network: For medicare-covered hospital stays:

- Days 1-10: $175 copay per day
- Days 11-90: $0 copay per day
- $0 copay for additional hospital days.

Out-of-Network: - $200 per day for days 1-10

- $0 each day beginning on day 11
Outpatient Hospital Care

In-Network: $0 - $175 copay for each Medicare-covered outpatient hospital facility visit or $100 copay for each Medicare-covered ambulatory surgical center visit.

Out-of-Network: 20% coinsurance
Part D Prescription Benefit No

Full Medvantage Plan Details:

Full plan details are available in PDF format.To access the document(s) Adobe Reader® must be installed on your computer. If you do not have Adobe Reader ®, you can download it for free by clicking here.

DISCLAIMER: The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact Florida Health Care Plans.