PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
First Medical Health Plan
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$0
Not Applicable
Specialist Office Visit
$7 maximum per visit
Not Applicable
Outpatient Services
$0
Not Applicable
Emergency Care
$50 maximum per visit
Not Applicable
Ambulance Services
$0
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-7: $50 copay per day. Days 8-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-5: $0 copay per day. Days 6-100: $25 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-7: $50 copay per day. Days 8-90: $0 copay per day
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$30 copay$30 copayNot offered
Tier 3: Preferred Brand Name$50 copay$50 copayNot offered
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$15 copay$15 copayNot offered
Tier 2: Non-Preferred Generic$90 copay$90 copayNot offered
Tier 3: Preferred Brand Name$150 copay$150 copayNot offered
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offered
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Improving bladder control
Not Rated
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability
Not Rated

Physician Finder

Physicians that accept First+Plus Smart Plus (HMO) for Puerto Rico

/
GMS MEDICAL GROUP P S C
145 CALLE GUARAGUAO
SAN JUAN, PR 00926
LBA MEDICAL SERVICES INC
145 CALLE GUARAGUAO
SAN JUAN, PR 00926
PEREZ-CUEVAS, HORTENSIA
287 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
HERRERO GRANDA, MANUEL
287 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
DIEZ-DELGADO, RICARDO
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
GUTIERREZ, NITZA
CARR # 8838 KM 5.6
SAN JUAN, PR 00926
FREYTES, RODRIGO
AVENIDA MUNOZ RIVERA 1002
SAN JUAN, PR 00927
PENA JIMENO, IVELISSE
346 CALLE 32
SAN JUAN, PR 00927
GARCIA SANTIAGO, ERNESTO
AVENIDA LUIS MUNOZ MARIN
CAGUAS, PR 00925
SUAREZ-PESANTE, JUAN
10 CALLE CASIA
SAN JUAN, PR 00921
DIEPPA, JULIO
271 DOMENECH ST
SAN JUAN, PR 00918
LATABAN, LIDYA
CLINICA LAS AMERICAS
SAN JUAN, PR 00918
MARTINEZ, ANTONIO
400 AVE DOMENECH
SAN JUAN, PR 00918
ROSADO, ARIEL
369 CALLE DE DIEGO STE 201
SAN JUAN, PR 00923
ESPIET, JUAN
431 AVE PONCE DE LEON
SAN JUAN, PR 00917
QUINTERO, ERIC
A4 CALLE ANICETO DIAZ
TRUJILLO ALTO, PR 00976
ROBLES MARTINEZ, MARIO
AVE APOLO A-2 ALTO APOLO
SAN JUAN, PR 00969
CORRALES HIGUERA, YURI
820 AVE ITURREGUI
SAN JUAN, PR 00924
GONZALEZ, NANNETTE
LODI ST
RIO PIEDRAS, PR 00924
GONZALES, MABEL
LODI ST
RIO PIEDRAS, PR 00924
COTT, HECTOR
D-12 BUEN SAMARITANO
GUAYNABO, PR 00966
LOPEZ, LOURDES
SAN RAFAEL MEDICAL PAVILION
SAN JUAN, PR 00909
CARDONA CAMPOS, IVAN
1409 FERIA STREET
SANTURCE, PR 00909
Details
GMS MEDICAL GROUP P S C
Phone Number
(787) 760-6604
Office Locations
145 CALLE GUARAGUAO
SAN JUAN, PR 00926
145 CALLE GUARAGUAO SAN JUAN PR, 00926

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