2007 Benefit Highlights - Freedom PPO
Plan
To compare Senior Care Plus with other Medicare
Advantage Plans, visit the Medicare
Compare Web page.
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SENIOR CARE PLUS
HIGHLIGHTS
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PREMIUM
HIGHLIGHTS
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FREEDOM
Rx+ PLAN
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Premium
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$188 monthly premium
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Premium includes:
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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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FREEDOM
Rx+ PLAN
Network Provider / Out of Network Provider
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Physician Office
Visits
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$10 / 20% for each primary care physician office visit.
$15 / 20% for each specialist visit.
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Inpatient
Hospital Care (Includes substance abuse and
rehabilitation services.)
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$100 / 20% for each Medicare covered stay in a
hospital, plus a $500 annual deducible.
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Outpatient Surgery
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$50 / 20% 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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10% / 20% for each Medicare-covered clinical/diagnostic
lab service.
10% / 20% for each Medicare-covered X-ray visit.
Office visit copayment may apply.
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Outpatient
Rehabilitation Services: Occupational,
Physical, Speech and Language Therapy
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10% / 20% for each visit.
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Annual Screening
Mammograms (For women with Medicare age 40 and older)
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$0 / 20% for each screening.
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Urgently Needed
Care
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$25 / 20% for each
visit to a Urgent Care center within the United
States.
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Emergency Care
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$50 for each emergency room visit. Coverage is worldwide.
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Ambulance Services
(Medically necessary)
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$0
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Annual
Out-Of-Pocket Maximum
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$2,500 (In Network)
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Note: Prior
authorization is required for certain services from Network Providers.
For
more information, please call Senior Care Plus. During Open Enrollment,
November 15, 2006 through March 1, 2007, 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, 2007, 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.
Revised October 2007
