PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
PUP
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:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,200 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
$5 maximum per visit
Not Applicable
Outpatient Services
$150 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$150 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
$0
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-3: $0 copay per day. Days 4-20: $45 copay per day. Days 21-100: $100 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-10: $100 copay per day. Days 11-90: $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 copayNot offered
Tier 2: Non-Preferred Generic$25 copay$25 copayNot offered
Tier 3: Preferred Brand Name$85 copay$85 copayNot offered
Tier 4: Non-Preferred Brand Name33% coinsurance33% coinsurance33% coinsurance
Tier 5: Specialty Tier
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$75 copay$75 copay$50 copay
Tier 3: Preferred Brand Name$255 copay$255 copay$255 copay
Tier 4: Non-Preferred Brand Name
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
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 PUP SIMPLE (HMO) for Florida

/
RENE N MAYORGA M D P A
14261 SW 120TH ST
MIAMI, FL 33186
PEREZ, RAIZA
9260 SW 72ND ST
MIAMI, FL 33173
RIOS, MARVIN
11880 SW 40TH ST
MIAMI, FL 33175
Details
RENE N MAYORGA M D P A
Phone Number
(305) 378-1302
Office Locations
14261 SW 120TH ST
MIAMI, FL 33186
14261 SW 120TH ST MIAMI FL, 33186

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question| 1 answer
over-the counter items
Q:Plan: pup simple hmo
Asked by pauline conley 

1 answer

Know the Answer? Answer this Question
A: Such specific benefits are currently not listed on our website. HealthPocket is an source of information and not a health plan or an insurance agent. For your specific benefits 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 2/6/2014 by davina

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