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SENIOR CARE PLUS HIGHLIGHTS
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| SERVICE HIGHLIGHTS |
VALUE PLAN |
| Physician Office Visits |
$10 copayment for each primary care physician office visit.
$40 copayment for each specialist visit.
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| Inpatient Hospital Care (Includes substance abuse and rehabilitation services.) |
$650 copayment for each Medicare covered stay in a network hospital. |
| Outpatient Surgery |
$250 copayment for outpatient surgery performed in an ambulatory surgical center or in the hospital. |
| Diagnostic Tests, X-Rays, and Lab Services |
$0 to $40 copayment for each Medicare-covered clinical/diagnostic lab service.
$40 copayment for each Medicare-covered X-ray visit.
Office visit copayment may apply. |
Outpatient Rehabilitation Services: Occupational Therapy
Physical Therapy
Speech and Language Therapy
|
$25 copayment for each visit. |
| Annual Screening Mammograms (For women with Medicare age 40 and older) |
$0 copayment
No referral necessary for network providers.
Office visit copayment may apply. |
| Urgently Needed Care |
$40 copayment for each visit to a Urgent Care center within the
United States. |
| Emergency Care |
$50 copayment for each emergency room visit. Coverage is worldwide. |
| Ambulance Services (Medically necessary)
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$100 copayment |
| Annual Out-Of-Pocket Maximum
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$4,500 |
Make the Smart Choice
For
more information, call Senior Care Plus at
775-982-3112 or 800-336-0123, Monday through Friday, 7:30 a.m. -
6:00 p.m. If you are hearing impaired, dial our TTY/TDD
number, 775-982-3240. You can also send a fax to 775-982-3110.
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