|
Retiree Rates effective 01.01.09
- 12.31.10
| Retiree over 65 enrolled in Medicare A&B
Rates |
|
Retiree Only
|
$382.95
|
| Retiree over 65 enrolled in Medicare A&B
Rates |
|
$10 Office Visit Copay
|
| Rx: Generic 10/20/Unlim. Brand 25/50/Unlim. Non-Formulary
50/100/Unlim |
| $50 ER Copay |
| $0 Ambulance Copay |
| $0 Inpatient Copay |
| $0 Outpatient Copay |
| Hearing Aid: $500 Allowance/36 months |
| Chiropratic: $10 Copay/12 visits |
| Vision: $10 Exam Copay; $75 Frame Allowance /
24 months |
| Caregiver: A solution for Caregivers is offered
by SeniorCo. Inc, a subsidary of PacifiCare Health Systems,
Inc. |
The proposed rates effective 1/1/2009 are
based on the benefits listed above. Medicare HMO rates may be changed
by PacifiCare in the event CMS or the State of Colorado changes
the approved benefit and premium package for the Medicare + Choice
Plan on in the event CMS changes the level of reimbursement to PacifiCare.
The above rates and benefits will apply if
the Secure Horizons Health Plan is enrolled for an effective date
of 1/1/2009 and will remain in effect for 12 months until 12/31/10
The Secure Horizons quote is based on membership
in: Pueblo, Colorado Springs, Denver counties.
PacifiCare reserves the right to modify its
Medicare+Choice service area based upon filings with CMS (Formerly
HCFA), effective January 1, 2004.
|
