Medvantage Plan with Optional Point of Service Benefit
(No Part D Prescription Benefit) 2011
Click Here for 2012 Benefits
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: 7 days a week / 8:00 a.m. - 8:00 p.m.
Click here to review the Basic Benefit Information Disclaimer
Click here to review the Online Enrollment Center Disclaimer
Benefits at a glance:
| Monthly Plan Premium | $42.00 (See Optional Point of Service Details) |
| Medical Annual Deductible | In- or Out-of-Network: $0 |
| Medical Out-of-Pocket Maximum | In-Network: $6,700 Out-of-Network: $0 |
| You must continue to pay your Medicare Part B premium. | |
| Our plan covers all Medicare-covered preventive services at no cost to you during your "Welcome to Medicare" physical exam and Annual Wellness exam. | |
BENEFITS |
YOU PAY |
Abdominal aortic aneurysm screening |
In-Network: $0 Out-of-Network: 20% coinsurance |
Bone mass measurement |
In-Network: $0 Out-of-Network: 20% coinsurance |
Colerectal Screening exams |
In-Network: $0 Out-of-Network: 20% coinsurance |
HIV screening |
In-Network: $0 Out-of-Network: 20% coinsurance |
Immunizations |
In-Network: $0 Out-of-Network: 20% coinsurance |
Mammograms |
In-Network: $0 Out-of-Network: 20% coinsurance |
Pap tests, Pelvic Exams and clinical breast exams |
In-Network: $0 Out-of-Network: 20% coinsurance |
Prostate Cancer Screening Exams |
In-Network: $0 Out-ofNetwork: 20% coinsurance |
Cardivascular disease testing |
In-Network: $0 Out-ofNetwork: 20% coinsurance |
Preventative Physical exam (Welcome to Medicare Physical Exam) |
In-Network: $0 Out-of-Network: 20% coinsurance |
Personalized Prevention Plan Services(Annual Wellness Exam) |
In-Network: $0 Out-of-Network: 20% coinsurance |
| 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: $40 copay per office visit Out-of-Network: 20% coinsurance |
| Inpatient Hospital Care | In-Network: For Medicare-covered hospital stays: - Days 1-8: $200 copay per day- Days 9-90: $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 - $200 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.
