2019 Select (HMO-POS SNP) H1587-003-000 in AR from Superior Select Health Plans | HealthPocket

Select (HMO-POS SNP)

$65/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderSuperior Select Health Plans
Plan IDH1587-003-000
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO-POS SNP
Annual Deductible$0.00
Out-of-Pocket Maximum

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2020. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$5.00
Monthly Drug Plan Premium$60.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,500 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:Not Applicable
Outpatient hospital coverageIn-Network:20% per visit
Doctor visitsPrimary:
In-Network:$0 copay
Specialist:
In-Network:$35 per visit
Preventive careIn-Network:$0 copay
Emergency care/Urgent careEmergency:$80 per visit (always covered)
Urgent care:$35 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:20%
Lab services:
In-Network:$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:$110-220
Outpatient x-rays:
In-Network:0%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:Not Applicable
Outpatient group therapy visit with a psychiatrist:
In-Network:20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:20%
Outpatient group therapy visit:
In-Network:20%
Outpatient individual therapy visit:
In-Network:20%
Skilled Nursing FacilityIn-Network:In 2019 the amounts for each benefit period are:
$0 copay for days 1 through 20
$170.50 copay per day for days 21 through 100
Out-of-Network:Not Applicable
Rehabilitation servicesOccupational therapy visit:
In-Network:10%
Physical therapy and speech and language therapy visit:
In-Network:10%
Ground ambulanceIn-Network:$150
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$35
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:10% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:20% per item
Diabetes supplies:
In-Network:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Other Part B drugs:
In-Network:20%

Benefits Services

Hearing
Hearing examIn-Network: 20%
Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass framesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for Select (HMO-POS SNP)

StateArkansas
CountyPulaski

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$2 copayNot offered
Tier 2: Non-Preferred GenericNot offereds$8 copayNot offered
Tier 3: Preferred Brand NameNot offereds$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offereds$100 copayNot offered
Tier 5: Specialty TierNot offereds33% coinsuranceNot offered
Tier 6: Select Care Drugs

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$4 copayNot offered
Tier 2: Non-Preferred GenericNot offereds$16 copayNot offered
Tier 3: Preferred Brand NameNot offereds$94 copayNot offered
Tier 4: Non-Preferred Brand NameNot offereds$200 copayNot offered
Tier 5: Specialty Tier
Tier 6: Select Care Drugs
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$6 copayNot offered
Tier 2: Non-Preferred GenericNot offereds$24 copayNot offered
Tier 3: Preferred Brand NameNot offereds$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offereds$300 copayNot offered
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

Managing Chronic Conditions

Special needs plan care management
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 fractureNot Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Controlling blood pressureNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quickly
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate
Statin Use in Persons with Diabetes

Physicians that accept Select (HMO-POS SNP) for Arkansas

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).