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SENIOR CARE PLUS
HIGHLIGHTS
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PREMIUM
HIGHLIGHTS
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VALUE PLAN
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VALUE PLUS
PLAN
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VALUE Rx PLAN
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VALUE Rx+
PLAN
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Premiums
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$0 monthly premium
(extra $15 to add preventive dental)
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$5.00 monthly premium
(extra $15 to add preventive dental)
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$25.00 monthly premium
(extra $15 to add preventive dental)
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$130 monthly premium
(comprehensive dental included)
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Differences in Premium include:
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(Medical benefits only) + preventive dental
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(Medical, Rx, and Vision benefits) + preventive dental
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(Medical, Rx, and Vision benefits) + preventive dental
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(Medical, Rx, Vision, and Dental benefits)
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SENIOR CARE PLUS
HIGHLIGHTS
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SERVICE
HIGHLIGHTS
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VALUE PLAN
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VALUE PLUS
PLAN
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VALUE Rx PLAN
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VALUE Rx+
PLAN
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Physician Office Visits
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$15 copay for PCP
$40 copay for specialists
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$15 copay for PCP
$40 copay for specialists
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$15 copay for PCP
$40 copay for specialists
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$15 copay for PCP
$30 copay for specialists
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Inpatient Hospital Care (Includes
substance abuse and rehabilitation services.)
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$200 per day (1-4 days) for each Medicare covered stay in
a network hospital.
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20% coinsurance for each Medicare covered stay in a
network hospital.
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$200 per day (1-4 days) for each Medicare covered stay in
a network hospital.
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$200 per day (1-3 days) for each Medicare covered stay in
a network hospital.
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Outpatient Surgery
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$200 copay 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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$200 copay for outpatient surgery performed in an
ambulatory surgical center or in the hospital.
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Diagnostic Tests, X-Rays, and Lab Services
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$0 to $50 copay for each Medicare-covered clinical /
diagnostic lab visit. $50 copay for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $50 copay for each Medicare-covered clinical /
diagnostic lab visit. $50 copay for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $50 copay for each Medicare-covered clinical /
diagnostic lab visit. $50 copay for each Medicare-covered X-Ray visit.
Office visit copay may apply.
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$0 to $50 copay for each Medicare-covered clinical /
diagnostic lab visit. $50 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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$25 copay for each visit
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$25 copay for each visit
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$25 copay for each visit
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$25 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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$20 copay for each visit to an Urgent Care center within
the United States.
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$20 copay for each visit to an Urgent Care center within
the United States.
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$20 copay for each visit to an Urgent Care center within
the United States.
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$15 copay for each visit to an 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 isworld-wide.
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Ambulance Services (medically necessary)
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$150 copay per trip.
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$150 copay per trip.
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$150 copay per trip.
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$100 copay per trip.
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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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$3,500
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For more information, please call Senior Care Plus. During Open
Enrollment, November 15, 2007 through March 1, 2008, Customer Services hours
will be Monday through Sunday, 8 a.m. to 8 p.m. Pacific Time, at 775-982-3112
or 1-800-336-0123. Beginning March 2,
2008, Customer Services will continue
their regular hours: Monday through Friday, 7:30 a.m. to 5:30 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.
