SeniorCare (Cost) HMO Plan 2012
SeniorCare (Cost) HMO Plan - Medicare HMO Health Plans and Part D Prescription Drug Plans
Enhance your Medicare Coverage with SeniorCare (Cost) HMO Health Plans and SeniorCare Rx (Cost) Prescription Drug Plans.
The Flexibility to Choose
Scott & White Health Plan offers a wide range of services and care designed for your needs. With five medical plans to choose from, you have the flexibility to select the coverage that's right for you.
Select($40.00 per month) Lowest monthly premium of all five plans |
Preferred($87.00 per month) |
VIP($125.00 per month) |
MedOption($148.00 per month) |
Premium($167.00 per month) |
| Flat co-payments for hospital stays, doctor visits and emergency room visits | Minimal co-payments for office visits and hospital stays | Low copayments for office visits and hospital stays | No copayments for office visits, hospital stays, or outpatient surgery | No co-payments for office visits, hospital stays or outpatient surgery |
| Moderate co-insurance for outpatient surgery/services, mental health care, substance abuse care, rehabilitation services and some tests |
Routine eye exams and eyewear coverage | Routine eye exam coverage | Hearing aid coverage | Routine eye exams and eyewear coverage
Preventive dental benefits Hearing aid coverage |
| Emergency care coverage within the U.S. | Worldwide emergency care coverage | Worldwide emergency care coverage | Worldwide emergency care coverage | Worldwide emergency care coverage |
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SeniorCare Rx available (additional premium required*)
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SeniorCare Rx available (additional premium required*)
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SeniorCare Rx available (additional premium required*)
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SeniorCare Rx available (additional premium required*)
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SeniorCare Rx available (additional premium required*)
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*Additional Premium for Value Rx is $30.60. |
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All Medical Plans Offer:
- Coverage of Medicare Part A and B deductibles
- Routine physical exams
- Local insurance agents to answer questions
- Coverage effective the first of the month following Medicare approval
- No waiting period on pre-existing conditions
- Premium not based on age, gender, or geographic location
- Virtually no claim forms
- Optional prescription drug coverage
- Access to Scott &White doctors
- Negotiated rates with providers
For a full description of benefits, see the 2012 Summary of Benefits 
.
The benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage.
You must receive all routine care from contracted providers.
SeniorCare Rx (Cost)
Scott & White Health Plan offers three prescription drug plans to compliment your SeniorCare (Cost) HMO medical coverage. Each prescription plan includes
- Medicare Part D coverage
- Thousands of network pharmacies, including chains and local stores across Texas
- Convenient home delivery mail-order service
- 90-day supply available for two co-payments on maintenance drugs
- Access to a complete range of generic and brand-name drugs
Let Us Help You
If you would like more information about our plans, please contact us. We can answer any questions you may have. Call us today at (800) 782-5068 or TTY/TDD (800) 735-2989.
Rates are illustrative only.
Do not send money until after you have been accepted for coverage.
You must fill out an application to apply for SeniorCare (Cost) HMO Plan coverage.
See Summary of Benefits for all benefit exclusions and limitations.
The above information is current as of October 2011.
Medicare-Approved HMO plan
H4564_WEB_SC_MAIN_2012REV CMS Approved 11/09/2011