Plan Details
NetworkCares (PPO SNP)
Ideal for those who have both Medicare and Medicaid.
_Premium
$0 per month
Enroll Now- Prescription drug coverage
- $0 annual eye exam
- Comprehensive and preventive dental
- SilverSneakers® fitness
- Hearing aid discount benefit
- Transportation benefit
- $150 annual over-the-counter allowance
- Meal delivery after an inpatient hospital stay
- Bathroom safety adaptation reimbursement
- Regular contact from specialized care coordinators
- Wellness Rewards program to earn up to $75 in gift cards
Additional Benefits
Over-the-Counter Allowance
To keep you healthy and well, our NetworkCares members receive a $150 annual over-the-counter allowance. Hundreds of useful items can be mailed directly to your home at no cost to you.
Meals
Recovering after an inpatient hospital stay can be difficult. That’s why Network Health partners with Mom’s Meals to provide NetworkCares members with 14 delicious meals delivered right to your door after a qualifying inpatient hospital stay.
Transportation
Need a ride to the dentist or to the doctor? We can help. Our partnership with Aryv helps you get to where you need to be, safely. The transportation benefit includes 12 one-way trips within the Network Health service area.
Bathroom Adaptation
NetworkCares offers a $300 annual reimbursement for approved bathroom home adaptation services and items. Contact the Network Health Concierge team for assistance with reimbursements.
Wellness Rewards
By completing three activities that are essential to your health and wellness, you can earn up to $75 in gift cards. It’s simply that easy to stay healthy.
- Receive a $25 gift card for your Annual Wellness Visit.
- Receive a $25 gift card for completing your annual Health Risk Assessment.
- Receive a $25 gift card for your flu shot.
Dental
Protecting your teeth and gums should be as routine as your annual wellness visit. Network Health Partners with Delta Dental® Medicare Advantage to offer NetworkCares members preventive and comprehensive dental care. For a quick summary of what’s included and frequently asked questions, click here. Visit Delta Dental's website to Find a Dental Provider.
Vision
Annual eye exams are an important part of your health care, so we partner with EyeMed® to offer our NetworkCares members an annual routine eye exam for a $0 copayment and up to $400 for eyewear. For a summary of what’s included and frequently asked questions, click here. Visit EyeMed's website to Find a Vision Provider.
Your Costs
NetworkCares (PPO SNP)
$0-$185 depending on your level of Medicaid eligibility
These amounts may change for 2020.
Out-of-Pocket
$10,000 for services you receive from any provider, your limit for services received from in-network providers will count towards this limit
Per admission.
In 2019 the amounts were:
$0 per day, Days 1-60
$341 per day, Days 61-90
$682 per day, Days 91 and beyond
(this plan covers 60 lifetime reserve days)
These amounts may change for 2020.
Including Ambulatory Surgical
Center Services such as
colonoscopies.
Doctor Visits
0%-20% of the cost out-of-network
Preventive Care
0%-20% of the cost out-of-network
Immunizations
Flu, Pneumonia, Hepatitis B
0%-20% of the cost out-of-network
Your cost is waived if admitted to a U.S. hospital within 24 hours.
$100,000 Maximum Benefit
Stress Test
Per service.
Services1
Such as MRIs, CT Scans.
Hearing Exam
Program
Includes a one-year warranty, three office visits, one pack of batteries and one year of loss and damage insurance. Maximum of two hearing aids per year.
Save $775-$1,215 per hearing aid.
Dental Exam
Does not include services in connection with care, treatment, filling, removal or replacement of teeth.
$0 Dental X-ray(s) (bitewing 1 per year, full mouth 1 every 5 years)
$0 Oral Exam (twice a year) $0 Basic Restorative Services
0%-50% of the cost for major services (endodontics/periodontics/extractions, prosthodontics, other oral/maxillofacial surgery, other services)
$3,000 Annual Maximum
One exam per year with an EyeMed provider.
$40 reimbursement out-of-network
Eyewear
Discounts offered at EyeMed providers.
$400 reimbursement out-of-network
Group Therapy, Psychiatric,
Telehealth
In 2019 the amounts were:
$0 per day, Days 1-60
$0-$341 per day, Days 61-90
$0-$682 per day, Days 91 and beyond
(this plan covers 60 lifetime reserve days)
These amounts may change for 2020.
Per admission.
$0 per day, Days 1-20
$0-$170.50 per day, Days 21-100
A prior three-day inpatient hospital stay is required. These amounts may change for 2020.
Speech Therapy
Includes comprehensive
outpatient rehabilitation facility.
Rehab
Maximum of 36 visits per year.
Diagnostic Tests
Genetic/molecular testing requires authorization1
machines, Prosthetic
Devices1
and Test Strips
One TouchTM and Accu-ChekTM
All other brands are not covered.
Training
For end stage renal disease
correct when one or more of
the bones of your spine move
out of position.
Health Care Visits1
Transportation
Your Drug Costs
NetworkCares (PPO SNP)
• In- and out-of-network: 0%-20% of the cost
Other Part B drugs1:
• In- and out-of-network: 0%-20% of the cost
Part D Prescription Drug Deductible on Tier 1
$0, Tiers 2-5: $420
PREFERRED RETAIL
COST-SHARING
Tier
For generic drugs (including
brand drugs treated as
generic), either:
For generic drugs (including
brand drugs treated as
generic), either:
(Preferred Generics)
• $1.30 copayment; or
•$3.60 copayment; or
lesser of $4 or 15% of the cost
• $1.30 copayment; or
•$3.60 copayment; or
lesser of $10 or 15% of the cost
(Generics and
Non-Preferred Generics)
• $1.30 copayment; or
• $3.60 copayment; or
lesser of $9 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment; or
lesser of $23 or 15% of the cost
(Non-Preferred
Generics and
Preferred Brands)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $42 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $105 or 15% of the cost
(Non-Preferred Generics
and Non-Preferred Brands)
• $1.30 copayment; or
•$3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $94 or 15% of the cost
• $1.30 copayment; or
•$3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $235 or 15% of the cost
(Specialty)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of 15% of the cost or 25% of the cost
STANDARD RETAIL
COST-SHARING
Tier
For generic drugs (including
brand drugs treated as
generic), either:
For generic drugs (including
brand drugs treated as
generic), either:
(Preferred
Generics)
• $1.30 copayment; or
•$3.60 copayment; or
lesser of $6 or 15% of the cost
• $1.30 copayment; or
•$3.60 copayment; or
lesser of $15; or 15% of the cost
(Generics and
Non-Preferred
Generics)
• $1.30 copayment; or
• $3.60 copayment; or
lesser of $15 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment; or
lesser of $38 or 15% of the cost
(Non-
Preferred
Generics and
Preferred Brands)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $47 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $118 or 15% of the cost
(Non-Preferred
Generics and
Non-Preferred Brands)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $100 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $250 or 15% of the cost
(Specialty)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of 15% of the cost or 25% of the cost
MAIL ORDER RETAIL
COST-SHARING
Tier
For generic drugs (including
brand drugs treated as
generic), either:
For generic drugs (including
brand drugs treated as
generic), either:
(Preferred
Generics)
• $1.30 copayment; or
• $3.60 copayment
lesser of $4 or 15% of the cost
(Generics and
Non-Preferred
Generics)
• $1.30 copayment; or
• $3.60 copayment
lesser of $9 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment
lesser of $23 or 15% of the cost
(Non-Preferred
Generics and
Preferred
Brands)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $42 or 15% of the cost
• $1.30 copayment; or
• $3.60 copaymentt
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $105 or 15% of the cost
(Non-Preferred
Generics and
Non-Preferred
Brands)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $94 or 15% of the cost
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of $235 or 15% of the cost
(Specialty)
• $1.30 copayment; or
• $3.60 copayment
For all other drugs, either:
• $0 copayment; or
• $3.90 copayment; or
• $8.95 copayment; or
lesser of 15% of the cost or 25% of the cost
CATASTROPHIC COVERAGE
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,350, you pay $0-$3.60 for drugs treated as generic and $0-$8.95 for drugs treated as brand.
Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.