PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Health Net
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?
Yes
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,800 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 maximum per visit
Not Applicable
Specialist Office Visit
$30 maximum per visit
Not Applicable
Outpatient Services
$100 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$350 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-5: $175 copay per day. Days 6-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-20: $25 copay per day. Days 21-100: $100 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-5: $175 copay per day. Days 6-90: $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$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$15 copay$15 copay
Tier 3: Preferred Brand Name$44 copay$44 copay$44 copay
Tier 4: Non-Preferred Brand Name$95 copay$95 copay$95 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$45 copay$45 copay$30 copay
Tier 3: Preferred Brand Name$132 copay$132 copay$122 copay
Tier 4: Non-Preferred Brand Name$285 copay$285 copay$275 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance

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
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
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

Physician Finder

Physicians that accept Health Net Ruby Select (HMO) for Arizona

/
LOMAGO, DEAN
1501 W 24TH ST
YUMA, AZ 85364
SULLIVAN, JOHN
1320 W 24TH ST
YUMA, AZ 85364
BAZZI, ALEIX
2095 W. 24TH STREET
YUMA, AZ 85364
RUNYAN, DONALD
2400 S AVENUE A
YUMA, AZ 85364
AMON, JOHN
2911 SOUTH 8TH AVENUE
YUMA, AZ 85364
GROGAN, BRIAN
2911 S 8TH AVE
YUMA, AZ 85364
GASCA-HOLTZ, MARIA
2911 S 8TH AVE
YUMA, AZ 85364
SUCIU, THOMAS
2911 S 8TH AVE
YUMA, AZ 85364
VINING, JAMES
2911 S 8TH AVE
YUMA, AZ 85364
WESTER-EBBINGHAUS, WERNER
2911 S 8TH AVE
YUMA, AZ 85364
GREGG, JAMES
2400 S AVENUE A
YUMA, AZ 85364
LWIN, TIN
2400 S AVE A
YUMA, AZ 85364
ZOELLNER, GARY
1501 W 24TH ST
YUMA, AZ 85364
GERAIS, MOHAMMED
2400 S AVENUE A
YUMA, AZ 85364
FAYAD, WISSAM
1841 W 25TH ST # A
YUMA, AZ 85364
SEVERINO, OLIVER
2060 W 24TH ST
YUMA, AZ 85364
VEMURI, SATHYA
2060 W 24TH ST
YUMA, AZ 85364
KARMAKAR, KANKA
2060 W 24TH ST
YUMA, AZ 85364
HATTON, RAYMOND
2060 W 24TH ST
YUMA, AZ 85364
WANG, CHING
2060 W 24TH ST
YUMA, AZ 85364
SHAH, ASHVIN
2110 W 24TH ST
YUMA, AZ 85364
SOMJEE, SAIKA
2060 W 24TH ST
YUMA, AZ 85364
CANNELL, ROBERT
2359 22ND DRIVE
YUMA, AZ 85364
DUQUE, WILBUR DON
2060 W 24TH ST
YUMA, AZ 85364
MITTAPALLI, RAJA
845 E B STREET
SAN LUIS, AZ 85349
Details
DEAN LOMAGO, M.D.
Phone Number
(928) 341-1981
Office Locations
1501 W 24TH ST
YUMA, AZ 85364
1501 W 24TH ST YUMA AZ, 85364

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
2 question| 1 answer
dental insurance with this plan
Q:
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: HealthPocket is an source of information and not a health plan or an insurance agent. For your specific benefit inquiry, it is best to speak with a licensed agent. The phone number and hours of operation is available when you click on 'Select'.
Answered on 1/25/2014 by davina
Need a list ofvdrs.
Q:I live in green valley az. What drs are in thevrubybselect plan?
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: You may try the Physician Directory tool beside the Community Q & A section, enter your zip code, then you will be able to see a list of network providers there.
Answered on 1/29/2014 by davina

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