Resumen de cobertura
¿Está mi médico en la red?
Beneficio: | Usted paga: |
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Visita al médico de cabecera | Level 1 $0 Copayment in-network |
Visita al especialista | Level 1 $30 Copayment in-network |
Atención para pacientes hospitalizados | $295 copay per day for days 1-5 in-network |
Servicios de emergencia (dentro y fuera de la red) | $90 copay; ER copay waived if admitted |
Servicios de urgencia | $40 copay in and out-of-network |
Cobertura para Medicinas Recetadas
Beneficio: | Usted paga: |
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Deducible para medicinas recetadas | $150 (applies to Tiers 3,4,5 only) |
Cobertura de medicinas recetadas dentro de la red - Cobertura inicial | Tier 1 - Preferred Generics |
Cobertura durante la brecha en la cobertura | This plan has coverage in the Part D coverage gap. Tier 1 (preferred generic drugs) and Tier 6 (select care) medications are covered in the coverage gap. For these tiers, you continue to pay the same cost-sharing amounts as in the Initial Coverage Stage. You pay no more than $0 for Tier 1 medications at a network retail pharmacy. You pay no more than $0 for Tier 6 medications at a network retail pharmacy. You will pay no more than 25% of the costs for generics in all other tiers. For all brand drugs you pay no more than 25% of the costs. |
Cobertura para Eventos Catastróficos | You pay the greater of $3.95 or 5% for generic drugs and drugs treated like generics. You pay the greater of $9.85 or 5% for brand name drugs. |
Cobertura adicional
Beneficio: | |
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Beneficios Adicionales | Routine Dental |
Cobertura Fuera de la Red:
Beneficio: | |
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Servicios/Suministros médicos | If you receive care from an out-of-network provider, your out-of-pocket costs will usually be higher than if you use a network provider. There are three exceptions: emergency care, urgently needed care and dialysis services. For details about the plan's coverage of out-of-network care, please refer to the Summary of Benefits or the Evidence of Coverage. (See "Plan Documents" below.) |
Medicinas recetadas | We generally cover drugs filled at an out-of-network pharmacy only if you are not able to use one of our network pharmacies (for example, because you are traveling, need emergency or urgent care, or need a drug that it not available at an accessible network pharmacy). Chapter 5 of the Evidence of Coverage provides a full list of situations in which we may cover drugs from an out-of-network pharmacy. |
Documentos del plan
Resumen de beneficios (PDF) |
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Constancia de Cobertura (PDF) |
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Calificación del plan (PDF) |
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Notificación general de transición (PDF) |
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Tabla de resumen de subsidios para la prima por bajos ingresos para quienes reciben ayuda adicional (PDF) |
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Formulario completo (PDF) |
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Mapa de áreas de servicio | |
Notificación Anual de Cambios |
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Formulario de Inscripción |
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Why Choose Florida Blue Medicare?
Online Member Portal
A secure members only website that keeps you in control of your health and wellness with a variety of easy-to-use tools.
Fitness Program
SilverSneakers gives you unlimited access to over 14,000 gyms and wellness programs. Enjoy services like fitness classes, treadmills, weights, pools and more at no extra cost to you.
Case Management Coordination of Care
A dedicated consultant to assist with coordinating appointments, in or outpatient stays, management of chronic conditions and help with finding the best price on procedures and prescriptions.
Florida Blue Centers/FHCP Centers
Enjoy face-to-face customer service, wellness events and educational seminars at one of our unique retail centers.
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