Florida · 2020. 9. 28. · Central Florida 2021 Plan Highlights 301 PLAN Simply Select (HMO)...
Transcript of Florida · 2020. 9. 28. · Central Florida 2021 Plan Highlights 301 PLAN Simply Select (HMO)...
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Florida
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Simply – Medicare Advantage Growth 2021
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Market Highlights
• 4-Star rated plan in SFL and CFL in 11 counties in serving over 63,000 Medicare Members.
• Extensive Portfolio and rich benefit offerings to meet the needs of your clients.
• Products such as HMO, D-SNP, and C-SNP focused products and Part B Give-back product offering.
• Local concierge unit to deliver high levels of customer service.
• All plans offer generous OTC, Vision, Hearing, and Enhanced Dental.
• Simply Healthcare Network includes key provider partners such as IMA Medical Group, CANO Health, IMC Health, CMG, Chen Medical, Palm Medical Centers, and many more.
Service Area
Broward, Hernando, Hillsborough, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole
Excludes HealthSun and America’s 1st Choice Footprint
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South Florida 2021 Plan Highlights
288
PLAN Simply More (HMO)H5471-065
Simply Extra (HMO)H5471-103
PREMIUM $0 $0
PCP $0 copay $0 copay
SPECIALIST $0 copay $15 copay
INPATIENT HOSPITAL $0 copay $50 copay (days 1 - 5)
MAX OUT-OF-POCKET $3,450 $3,450
RX DEDUCTIBLE $0 $0
RX COPAYT1/T2/T3/T4/T5 $0 / $0 / $0 / $5 / 33% $0 / $10 / $47 / $100 / 33%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®, Transportation,
Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Miami-Dade Miami-Dade
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South Florida 2021 Plan Highlights
289
PLAN Simply Level (HMO C-SNP)H5471-069
Simply Complete (HMO D-SNP)H5471-064
PREMIUM $0 $0
PCP $0 copay $0 copay
SPECIALIST $0 copay $0 copay
INPATIENT HOSPITAL $0 copay $0 copay
MAX OUT-OF-POCKET $3,450 $500
RX DEDUCTIBLE $0 $445 (T3 – T5)
RX COPAYT1/T2/T3/T4/T5 $0 / $0 / $0 / $10 / 33% $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®, Transportation,
Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency
Response System, Podiatry, SilverSneakers®, Simply Aide, Transportation, Vision
MARKET SERVICE AREA Miami-Dade Miami-Dade
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South Florida 2021 Plan Highlights
290
PLAN Simply More (HMO)H5471-077
Simply Extra (HMO)H5471-104
PREMIUM $0 $0
PCP $0 copay $0 copay
SPECIALIST $0 copay $25 copay
INPATIENT HOSPITAL $0 copay $200 copay (days 1 - 5)
MAX OUT-OF-POCKET $3,450 $3,450
RX DEDUCTIBLE $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $25 / $75 / 33% $5 / $20 / $47 / $100 / 33%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry, SilverSneakers®,
Transportation, Vision
MARKET SERVICE AREA Broward Broward
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South Florida 2021 Plan Highlights
291
PLAN Simply Select (HMO)H5471-100
LIS ELIGIBILITY No LIS 25% Subsidy 50% Subsidy 75% Subsidy 100% Subsidy
PREMIUM1 $24.10 $18.10 $12.00 $6.00 $0
PCP $0 copay
SPECIALIST $5 copay
INPATIENT HOSPITAL $0 copay
MAX OUT-OF-POCKET $3,450
EXTRA HELP LEVEL No Extra Help Level 4 Level 1 Level 2 Level 3
RX DEDUCTIBLE $445 (T3 – T5) $92 $0 $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0/$0/25%/25%/25% $0 to 15% $0 - $9.20 $0 - $4 $0
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Broward
12020 premiums listed
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South Florida 2021 Plan Highlights
292
PLAN Simply Level (HMO C-SNP)H5471-080
Simply Complete (HMO D-SNP)H5471-076
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $500
PCP $0 copay $0 copay
SPECIALIST $5 copay $0 copay
INPATIENT HOSPITAL $0 copay $0 copay
RX DEDUCTIBLE $0 $445 (T3 – T5)
RX COPAYT1/T2/T3/T4/T5 $0 / $0 / $35 / $75 / 33% $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency
Response System, Podiatry, SilverSneakers®, Simply Aide, Transportation, Vision
MARKET SERVICE AREA Broward Broward
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South Florida 2021 Plan Highlights
293
PLAN Simply More (HMO)H5471-083
Simply Extra (HMO)H5471-105
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $3,450
PCP $0 copay $0 copay
SPECIALIST $10 copay $40 copay
INPATIENT HOSPITAL $50 copay (days 1 – 8) $225 copay (days 1 – 8)
RX DEDUCTIBLE $0 $100 (T3 – T5)
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $20 / $75 / 33% $10 / $20 / $47 / $100 / 31%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry, SilverSneakers®,
Transportation, Vision
MARKET SERVICE AREA Palm Beach Palm Beach
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South Florida 2021 Plan Highlights
294
PLAN Simply Select (HMO)H5471-101
LIS ELIGIBILITY No LIS 25% Subsidy 50% Subsidy 75% Subsidy 100% Subsidy
PREMIUM1 $20.20 $15.10 $10.10 $5.00 $0
MAX OUT-OF-POCKET $3,450
PCP $0 copay
SPECIALIST $5 copay
INPATIENT HOSPITAL $0 copay
EXTRA HELP LEVEL No Extra Help Level 4 Level 1 Level 2 Level 3
RX DEDUCTIBLE $445 (T3 – T5) $92 $0 $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0/$0/25%/25%/25% $0 to 15% $0 - $9.20 $0 - $4 $0
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Palm Beach
12020 premiums listed
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South Florida 2021 Plan Highlights
295
PLAN Simply Complete (HMO D-SNP)H5471-084
Simply Level (HMO C-SNP)H5471-085
PREMIUM $0 $0
MAX OUT-OF-POCKET $500 $3,450
PCP $0 copay $0 copay
SPECIALIST $0 copay $10 copay
INPATIENT HOSPITAL $0 copay $50 copay (days 1 – 8)
RX DEDUCTIBLE $445 (T3 – T5) $0
RX COST SHARET1/T2/T3/T4/T5 $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20 $0 / $0 / $35 / $75 / 33%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®,
Simply Aide, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, In-Home Support, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance,
Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Palm Beach Palm Beach
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Central Florida 2021 Plan Highlights
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PLAN Simply More (HMO)H5471-071
PREMIUM $0
MAX OUT-OF-POCKET $3,450
PCP $0 copay
SPECIALIST $5 copay
INPATIENT HOSPITAL $40 copay (days 1 – 5)
RX DEDUCTIBLE $0
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $10 / $55 / 33%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Polk
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Central Florida 2021 Plan Highlights
297
PLAN Simply Level (HMO C-SNP)H5471-070
Simply Complete (HMO D-SNP)H5471-066
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $500
PCP $0 copay $0 copay
SPECIALIST $5 copay $0 copay
INPATIENT HOSPITAL $0 copay $0 copay
RX DEDUCTIBLE $0 $445 (T3 – T5)
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $0 / $40 / 33% $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®,
Simply Aide, Transportation, Vision
MARKET SERVICE AREA Polk Polk
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Central Florida 2021 Plan Highlights
298
PLAN Simply More (HMO)H5471-078
Simply More (HMO)H5471-074
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $3,450
PCP $0 copay $0 copay
SPECIALIST $10 copay $15 copay
INPATIENT HOSPITAL $50 copay (days 1 – 8) $75 copay (days 1 – 8)
RX DEDUCTIBLE $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $35/ $75 / 33% $0 / $0 / $25 / $75 / 33%
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Hernando, Hillsborough, Pasco, Pinellas Orange, Osceola, Seminole
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Central Florida 2021 Plan Highlights
299
PLAN Simply Select (HMO)H5471-099
LIS ELIGIBILITY No LIS 25% Subsidy 50% Subsidy 75% Subsidy 100% Subsidy
PREMIUM1 $28.50 $21.40 $14.30 $7.10 $0
MAX OUT-OF-POCKET $3,450
PCP $0 copay
SPECIALIST $5 copay
INPATIENT HOSPITAL $25 copay (days 1 – 8)
EXTRA HELP LEVEL No Extra Help Level 4 Level 1 Level 2 Level 3
RX DEDUCTIBLE $445 (T3 – T5) $92 $0 $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0/$0/25%/25%/25%
$0 to 15% coinsurance
$0 - $9.20 $0 - $4 $0
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Hernando, Hillsborough, Pasco, Pinellas
12020 premiums listed
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Central Florida 2021 Plan Highlights
300
PLAN Simply Level (HMO C-SNP)H5471-075
Simply Complete (HMO D-SNP)H5471-082
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $500
PCP $0 copay $0 copay
SPECIALIST $10 copay $0 copay
INPATIENT HOSPITAL $50 copay (days 1 – 8) $0 copay
RX DEDUCTIBLE $0 $445 (T3 – T5)
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $35 / $75 / 33% $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency
Response System, Podiatry, SilverSneakers®, Simply Aide, Transportation, Vision
MARKET SERVICE AREA Hernando, Hillsborough, Pasco, Pinellas Hernando, Hillsborough, Pasco, Pinellas
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Central Florida 2021 Plan Highlights
301
PLAN Simply Select (HMO)H5471-098
LIS ELIGIBILITY No LIS 25% Subsidy 50% Subsidy 75% Subsidy 100% Subsidy
PREMIUM1 $28.50 $21.40 $14.30 $7.10 $0
MAX OUT-OF-POCKET $3,450
PCP $0 copay
SPECIALIST $10 copay
INPATIENT HOSPITAL $25 copay (days 1 – 8)
EXTRA HELP LEVEL No Extra Help Level 4 Level 1 Level 2 Level 3
RX DEDUCTIBLE $445 (T3 – T5) $92 $0 $0 $0
RX COST SHARET1/T2/T3/T4/T5 $0/$0/25%/25%/25%
$0 to 15% coinsurance
$0 - $9.20 $0 - $4 $0
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency Response System, Podiatry, SilverSneakers®, Transportation, Vision
MARKET SERVICE AREA Orange, Osceola, Seminole
12020 premiums listed
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Central Florida 2021 Plan Highlights
302
PLAN Simply Level (HMO C-SNP)H5471-073
Simply Complete (HMO D-SNP)H5471-072
PREMIUM $0 $0
MAX OUT-OF-POCKET $3,450 $500
PCP $0 copay $0 copay
SPECIALIST $10 copay $0 copay
INPATIENT HOSPITAL $75 copay (days 1 – 8) $0 copay
RX DEDUCTIBLE $0 $445 (T3 – T5)
RX COST SHARET1/T2/T3/T4/T5 $0 / $0 / $25 / $75 / 33% $0 / $0-$3.70 / $0-$9.20 / $0-$9.20 / $0-$9.20
KEY EXTRA BENEFITS Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Podiatry,
SilverSneakers®, Transportation, Vision
Acupuncture, Chiropractic, Dental, Hearing, LiveHealth Online, Meals, Nurse HelpLine, OTC Allowance, Personal Emergency
Response System, Podiatry, SilverSneakers®, Simply Aide, Transportation, Vision
MARKET SERVICE AREA Orange, Osceola, Seminole Orange, Osceola, Seminole