2012 Medvantage Rx Plan
Questions:
If you have questions or require assistance, please call:
FHCP's Marketing Department at 1-800-232-0578, TTY users please call TTY: TRS Relay 711.
Hours of operation: 7 days a week / 8:00 a.m. - 8:00 p.m.
Click here to review the Basic Benefit Information Disclaimer
Click here to review the Online Enrollment Center Disclaimer
Online Enrollment Available October 15th 2011! |
2012 Benefits at a glance
Click here to see 2011 Benefits
PREMIUM AND OTHER IMPORTANT INFORMATION:
Monthly Premium:
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Maximum Medical Out-of-Pocket:
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Plan Premiums for Beneficiaries with Extra Help
*You must continue to pay your Medicare Part B premium.
PHYSICIAN SERVICES:
Primary Care Physician:
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Specialist
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| Doctor Choice: | You must select your Primary Care Physician from our extensive network |
| Specialist Referral Required: | Yes, for certain services |
INPATIENT CARE:
Inpatient Hospital Care: |
$200 per day (days 1-8) |
Skilled Nursing Facility: |
$0 per day (days 1-7) |
| $50 per day (days 8-100) |
PART D PRESCRIPTION BENEFIT:
| Part D Annual Deductible: | $150 |
|
Tier 1 – Preferred Generic |
20%* coinsurance |
86%* coinsurance |
$2.60***** copay |
|---|---|---|---|
Tier 2 – Non-Preferred Generic |
20%* coinsurance |
86%* coinsurance |
$2.60***** copay |
Tier 3 – Preferred Brand |
25%* coinsurance |
50%* coinsurance |
$6.50***** copay |
Tier 4 – Non-Preferred Brand |
60%* coinsurance |
50%* coinsurance |
$6.50***** copay |
Tier 5 – Specialty Tier |
29%* coinsurance |
86%* coinsurance Generic 50%* coinsurance Brand |
$2.60***** copay Generic $6.50***** copay Brand |
Tier 6 – Injectable |
25%* coinsurance |
86%* coinsurance Generic 50%* coinsurance Brand |
$2.60***** copay Generic $6.50***** copay Brand |
*What you pay per prescription for a 31-day supply at a Florida Health Care Plans Preferred Pharmacy.
** INITIAL COVERAGE LEVEL – You pay the following until total yearly drug costs reach $2,930
*** COVERAGE GAP - After your total yearly drug costs reach $2,930, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 86% of the plan’s costs for generic drugs until your yearly out-of-pocket drug costs reach $4,700.
**** CATASTROPHIC COVERAGE - What you pay after your yearly out-of-pocket drugs cost $4,700
***** or 5% whichever is less
OUTPATIENT CARE:
Outpatient Mental Health Care: |
$30 copay for each Medicare-covered individual or group therapy visit |
|---|---|
Outpatient Substance Abuse Care: |
$30 copay for each Medicare-covered individual or group therapy visit |
Outpatient Services/Surgery: |
$100 copay for each Medicare-covered ambulatory surgical center visit. |
| $0 to $200 copay for each Medicare-covered outpatient hospital facility visit | |
Emergency Care: |
$65 copay for Medicare-covered emergency room visits Worldwide coverage |
Urgently Needed Care: |
$30 copay for Medicare-covered urgently needed care visits |
Ambulance Services: |
$175 copay for Medicare-covered ambulance benefits |
Outpatient Rehabilitation Services: |
$30 copay for Medicare-covered Occupational Therapy visits, Physical and/or Speech and Language Therapy visits. |
OUTPATIENT MEDICAL SERVICES AND SUPPLIES
Durable Medical Equipment: |
20% of the cost for Medicare-covered items |
|---|---|
Prosthetic Devices: |
20% of the cost for Medicare-covered items |
Diagnostic Tests, X-rays, Lab Services, and Radiology Services:
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$0 copay for Medicare-covered lab services |
| $0 to $175 copay for Medicare-covered diagnostic procedures and tests | |
| $10 to $25 copay for Medicare-covered X-rays | |
| $10 to $200 copay for Medicare-covered diagnostic radiology services | |
| $10 to $25 copay for Medicare-covered therapeutic radiology services | |
Cardiac and Pulmonary Rehabilitation Services:
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$30 copay for Medicare-covered Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, and Pulmonary Rehabilitation Services |
Hearing Services: |
$0 copay for Medicare-covered diagnostic hearing exams |
| $0 copay for: | |
|
|
Vision Services: |
$15 copay for a Medicare-covered eye exam by an Optometrist |
| $30 copay for a Medicare-covered eye exam by an Ophthalmologist, referral required | |
| Covered up to a $90 credit toward the purchase of eyeglasses from a participating Optometrist every two years |
ADDITIONAL BENEFITS:
- Preferred Fitness program - access to over 30 contracted gyms in Volusia & Flagler Counties
- 24-Hour Member Only Nurse line - English and Spanish
- Member Portal and Welcome to Wellness online Health Risk Assessment - providing education and programs to help FHCP Medvantage Members take a more active role in their healthcare.
- Matter of Balance
To View Full Medvantage RX 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.
