2018 Traditional Plus-SF (HMO) H5496-9-0 in CA from Imperial Health Plan of California, Inc. | HealthPocket

Traditional Plus-SF (HMO)

$35/mo

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Zip Code90011
Applicant12/14/1983 Male
Coverage Start12/16/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderImperial Health Plan of California, Inc.
Plan IDH5496-9-0
Plan Year2018
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$405.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

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

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$4,000 In-network
Other health plan deductibles?No
Health Plan DeductibleComing soon
Monthly Drug Plan Premium$35.50
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverageComing soon
Outpatient hospital coverage20% per visit
Doctor visitsPrimary:
20% per visit
Specialist:
20% per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:
20% per visit (always covered)
Urgent care:
20% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
20%
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
20%
Mental health servicesComing soon
Outpatient group therapy visit with a psychiatrist:
20%
Outpatient individual therapy visit with a psychiatrist:
20%
Outpatient group therapy visit:
20%
Outpatient individual therapy visit:
20%
Skilled Nursing FacilityComing soon
Rehabilitation servicesOccupational therapy visit:
20%
Physical therapy and speech and language therapy visit:
20%
Ambulance20%
Transportation$0 copay
Foot care (podiatry services)Foot exams and treatment:
20%
Routine foot care:
$0 copay
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Traditional Plus-SF (HMO)

StateCalifornia
CountyLos Angeles

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


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 5: Specialty TierNot offered25% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 5: Specialty Tier

Physicians that accept Traditional Plus-SF (HMO) for California

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.