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SENIOR CARE PLUS
HIGHLIGHTS
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SERVICE
HIGHLIGHTS
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VALUE BASIC PLAN
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VALUE Rx
PLAN
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VALUE Rx ENHANCED
PLAN
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VALUE Rx PREMIER
PLAN
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Physician Office Visits
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$10 copay for PCP
$40 copay for specialists
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$10 copay for PCP
$40 copay for specialists
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$10 copay for PCP
$40 copay for specialists
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$10 copay for PCP
$30 copay for specialists
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Inpatient
Hospital Care:
(Includes substance abuse and rehabilitation services.)
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$250 per day (1-4 days) for each Medicare covered stay
in a network hospital. (*per service period)
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$250 per day (1-4 days) for each Medicare covered stay in
a network hospital. (*per service period)
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$200 per day (1-3 days) for each Medicare covered stay in
a network hospital. (*per service period)
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$150 per day (1-3 days) for each Medicare covered stay in
a network hospital. (*per service period)
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*There are no additional copayments for Inpatient Hospital-Acute Services
when readmitted to a contracted facility during a "service" period or within 30 days of last discharge. A "service" period starts
the day you go into a hospital and ends when you go for 30 days without hospital care. If you go into the hospital after one
"service" period has ended, a new "service" period begins. You must pay the inpatient hospital copayments for each "service" period.
There is no limit to the number of "service" periods you can have in one year.
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Outpatient Surgery
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20% coinsurance for outpatient surgery performed in an ambulatory surgical center or in the hospital.
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20% coinsurance for outpatient surgery performed in an ambulatory surgical center or in the hospital.
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$200 copay for outpatient surgery performed in an ambulatory surgical center or in the hospital.
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$150 copay for outpatient surgery performed in an ambulatory surgical center or in the hospital.
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Home Health Care:
(medically necessary)
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0$ copay for each visit
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0$ copay for each visit
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0$ copay for each visit
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0$ copay for each visit
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Diagnostic Tests, X-Rays, and Lab Services
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$0 to $100 copay for each
Medicare-covered clinical / diagnostic lab service. $50 to $75 copay
for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $100 copay for each
Medicare-covered clinical / diagnostic lab service. $50 to $75 copay
for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $100 copay for each
Medicare-covered clinical / diagnostic lab service. $50 to $75 copay
for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $100 copay for each
Medicare-covered clinical / diagnostic lab service. $25 to $75 copay
for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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Outpatient Rehabilitation Services: Occupational, Physical, Speech and Language
Therapy
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$20 copay for each visit
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$20 copay for each visit
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$20 copay for each visit
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$20 copay for each visit
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Annual Screening Mammograms (for women with Medicare age 40 and older)
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$0 copay, Office visit copay may apply
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$0 copay, Office visit copay may apply
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$0 copay, Office visit copay may apply
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$0 copay, Office visit copay may apply
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Urgently Needed Care
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$25 copay for each visit to a contracted Urgent Care center / $50 copay for each visit to a non-contracted Urgent Care center
within the United States.
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$25 copay for each visit to a contracted Urgent Care center / $50 copay for each visit to a non-contracted Urgent Care center
within the United States.
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$25 copay for each visit to a contracted Urgent Care center / $50 copay for each visit to a non-contracted Urgent Care center
within the United States.
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$25 copay for each visit to a contracted Urgent Care center / $40 copay for each visit to a non-contracted Urgent Care center
within the United States.
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Emergency Care
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$50 copay for each emergency
room visit. Coverage is world-wide.
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$50 copay for each emergency
room visit. Coverage is world-wide.
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$50 copay for each emergency
room visit. Coverage is world-wide.
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$50 copay for each emergency
room visit. Coverage is world-wide.
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Ambulance Services
(medically necessary)
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30% coinsurance per trip.
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30% coinsurance per trip.
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30% coinsurance per trip.
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20% coinsurance per trip.
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Over-the-Counter (OTC) Medications
(Medicare Part B)
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Select medications have a $5 copayment (30-day supply).
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Select medications have a $5 copayment (30-day supply).
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Select medications have a $5 copayment (30-day supply).
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Select medications have a $5 copayment (30-day supply).
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Annual Out-of-Pocket Maximum
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$4,000
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$4,000
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$3,500
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$3,000
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For more information, please call Senior Care Plus. During Annual and Open
Enrollment, November 15, 2008 through March 1, 2009, Customer Services hours will be Monday
through Sunday, 7:30 a.m. to 8 p.m. Pacific Time, at 775-982-3112 or 1-800-336-0123. Beginning
March 2, 2009, Customer Services will continue their regular hours: Monday through Friday,
7:30 a.m. to 8 p.m. Pacific Time. If you have impaired hearing, dial our TTY/TDD number,
775-982-3240. You can also send a fax to 775-982-3741.
