2019 Network PlatinumPremier (PPO) H5215-6-0 in WI from Network Health | HealthPocket

Network PlatinumPremier (PPO)

$195/mo

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Zip Code53215
Applicant6/16/1984 Male
Coverage Start6/17/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderNetwork Health
Plan IDH5215-6-0
Plan Year2019
CMS Rating
Plan TypePPO
Annual Deductible$0.00

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$195.00
Monthly Drug Plan PremiumNot Applicable
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In and Out-of-network
$3,400 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$75 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:$75 per day for days 1 through 5
$0 per day for days 6 and beyond
Outpatient hospital coverageIn-Network:$0 copay
Out-of-Network:$0 copay
Doctor visitsPrimary:
In-Network:$10 per visit
Out-of-Network:$10 per visit
Specialist:
In-Network:$20 per visit
Out-of-Network:$20 per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$120 per visit (always covered)
Urgent care:$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0 copay
Out-of-Network:$0 copay
Lab services:
In-Network:$0 copay
Out-of-Network:$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:$0 copay
Out-of-Network:$0 copay
Outpatient x-rays:
In-Network:$0 copay
Out-of-Network:$0 copay
Mental health servicesInpatient hospital - psychiatric:
In-Network:$0 copay
Out-of-Network:$0 copay per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:$0 copay
Out-of-Network:$0 copay
Outpatient individual therapy visit with a psychiatrist:
In-Network:$0 copay
Out-of-Network:$0 copay
Outpatient group therapy visit:
In-Network:$0 copay
Out-of-Network:$0 copay
Outpatient individual therapy visit:
In-Network:$0 copay
Out-of-Network:$0 copay
Skilled Nursing FacilityIn-Network:$0 copay
Out-of-Network:$0 copay
Rehabilitation servicesOccupational therapy visit:
In-Network:$20
Out-of-Network:$20
Physical therapy and speech and language therapy visit:
In-Network:$20
Out-of-Network:$20
Ground ambulanceIn-Network:$0 copay
Out-of-Network:$0 copay
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$20
Out-of-Network:$20
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:$0 copay
Out-of-Network:$0 copay
Prosthetics (e.g., braces, artificial limbs):
In-Network:$0 copay
Out-of-Network:$0 copay
Diabetes supplies:
In-Network:$0 copay
Out-of-Network:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:20%
Other Part B drugs:
In-Network:20%
Out-of-Network:20%

Benefits Services

Hearing
Hearing examIn-Network: $0 copay
Out-of-Network: $0 copay
Fitting/evaluationNot covered
Hearing aidsIn-Network: $1,220-1,985
Out-of-Network: $1,220-1,985
There may be limits on how much the plan will provide.
Preventive Dental
Office visitIn-Network: $30.00
Out-of-Network: 100%
Oral examCovered under office visit. There may be limits on how much the plan will provide.
CleaningCovered under office visit. There may be limits on how much the plan will provide.
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: $10
Out-of-Network: 100%
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Network PlatinumPremier (PPO)

StateWisconsin
CountyMilwaukee

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

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 fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

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

Member Complaints, and Changes in Drug Plan's Performance

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

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
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 Network PlatinumPremier (PPO) for Wisconsin

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Nancy, Nguyen
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Sahibzada, Latif
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Tyler, Steward
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Joshua, Neubauer
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Michael, Lischak
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Christopher, Adams
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Anwer, Dhala
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Jasbir, Sra
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Steven, Murphy
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Jessica, Kuester
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Moitreyee, Reddy
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Maher, Fattouh
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Yogendra, Bharat
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Hany, Nosir
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Thomas, Stauss
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Donald, Harvey
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Scott, Aschenbrener
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Denise, Sadler
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Marco, Araujo
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Gregg, Gaylord
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Jeremy, Scarlett
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Carol, Wood
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Jacqueline, Gerhart
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Kevin, Polglaze
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Nancy Nguyen, M.D.
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  • Phone Number
    (414) 672-1353
  • Office Locations
    2906 S 20th St
    Milwaukee, WI 53215
2906 S 20th St Milwaukee WI, 53215

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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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)