Medvantage Plan with Option Point of Service Benefit
(No Part D Prescription Benefit) 2008
Questions:
If you have questions or require assistance, please call:
FHCP’s Marketing Department at 1-800-232-0578,
Hours of Operation:
- November 15 through March 1 from 8 am to 8 pm – 7 days a week
- March 2 through November 14 from 8 am to 8 pm - Monday through Friday Only.
Benefits at a glance:
| Monthly Plan Premium | $47 (See Optional Point of Service Details) |
| Medical Annual Deductible | In- or Out-of-Network: $0 |
| Medical Out-of-Pocket Maximum | In-Network: $3250 Out-of-Network: $0 |
| 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 per visit Out-of-Network: 20% coinsurance |
| Specialist Office Visit | In-Network: $30 per office visit Out-of-Network: 20% coinsurance |
| Inpatient Hospital Care | In-Network: $200 per day for days 1-5 Out-of-Network: $200 per day for days 1-10 |
| Outpatient Hospital Care | In-Network: $75-$150 per Medicare-covered outpatient hospital facility visit or 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.
