Western Slope Plan Highlights

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Western Slope Benefit Comparison Highlights 2010

RMHP offers plan choice! Our Medicare plans offer Medicare beneficiaries comprehensive coverage, access to quality health care, and excellent customer service.

The following grid provides a quick, at-a-glance summary of our Western Slope Medicare Plans available. For a detailed 2010 Summary of Benefits, click on the link. For a detailed 2010 Summary of Benefits for the Medical-only (Cost) Plans, click on the link.

For the 2010 Evidence of Coverage, click on the link. This document provides more detailed information about:

Conditions associated with receipt or use of benefits
Out-of-network coverage
Grievance, coverage determinations, appeals procedures and exceptions process (For plans with Part D Prescription Drug coverage, see Chapter 9 of the EOC. For medical-only plans, see Chapter 7 of the EOC.)
Quality assurance policies and procedures, including medication therapy management, and drug and/or utilization management
Potential for contract termination
Beneficiaries' and plan's rights and responsibilities upon disenrollment

Click here for a Printable Western Slope Plan Highlights Grid below.

Medicare Covered Benefit	Green Plan + Rx (Cost) You Pay	Thrifty Plan + Rx (Cost) You Pay	Standard Plan + Rx (Cost) You Pay	Plus Plan + Rx (Cost) You Pay

Monthly Health Plan Premium Medical Prescription Drug Total	$0.00 $31.60 $31.60 * plus you must continue to pay Medicare Part B premium	$34.00 $38.70 $72.70 * plus you must continue to pay Medicare Part B premium	$74.00 $40.70 $114.70 * plus you must continue to pay Medicare Part B premium	$160.00 $76.20 $236.20 * plus you must continue to pay Medicare Part B premium
Medical Deductible	$500 per calendar year. Includes all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services.	None	None	None
Medical Out of Pocket Maximum	$5,000 per calendar year for in-network Medicare-covered services. Medicare-covered services do not include care received out of the country, routine vision or hearing exams, annual physical, or hospice consultation.	None	None	None
Primary Care Physician Office Visit Copayment	$15 per visit	$20 per visit	$15 per visit	$15 per visit
Specialist Care Physician Office Visit Copayment	$30 per visit	$40 per visit	$35 per visit	$25 per visit
Inpatient Hospital Copayment	$210 copay per day up to 7 days	$200 copay per day up to 5 days	$500 per admission	$450 per admission
Outpatient Surgery	$350 per visit	$350 per visit	$250 per visit	$250 per visit
Ambulance	$150 per trip	$150 per trip	$100 per trip	$100 per trip
Emergency Room	$50 per visit Worldwide	$50 per visit within the United States	$50 per visit within the United States	$50 per visit Worldwide
Urgent Care	$30 per visit Worldwide	$40 per visit within the United States	$35 per visit within the United States	$25 per visit Worldwide
Part D Prescription Drug Benefit	$120 Deductible- brand only	$115 Deductible- brand only	No deductible	No deductible
	$12 copay generic $36 copay preferred brand $56 copay nonpreferred brand 30% specialty	$12 copay generic $40 copay preferred brand $60 copay nonpreferred brand 30% specialty	$10 copay generic $40 copay preferred brand $60 copay nonpreferred brand 33% specialty	$8.50 copay generic $36 copay preferred brand $56 copay nonpreferred brand 33% specialty
	After $2,830 in total drug expenses you pay 100% of cost until you reach $4,550 out of pocket drug costs	After $2,830 in total drug expenses you pay 100% of cost until you reach $4,550 out of pocket drug costs	After $2,830 in retail drug expenses you pay 100% of cost until you reach $4,550 out of pocket drug costs	After $2,830 in retail drug expenses you pay $8.50 copay for generic drugs on Tier 1 only and 100% of cost for all other drugs until you reach $4,550 out of pocket drug costs
	Beneficiary pays $2.50 copay generic; $6.30 copay for all other drugs; OR 5% (whichever is higher)	Beneficiary pays $2.50 copay generic; $6.30 copay for all other drugs; OR 5% (whichever is higher)	Beneficiary pays $2.50 copay generic; $6.30 copay for all other drugs; OR 5% (whichever is higher)	Beneficiary pays $2.50 copay generic; $6.30 copay for all other drugs; OR 5% (whichever is higher)
Annual Routine Physical Exam	$0	$0	$0	$0
Preventive Screening Services	$0	$0	$0	$0
Skilled Nursing Facility	$0 days 1-7 $100 days 8-100	$0 days 1-10 $100 days 11-100	$0 days 1-14 $95 days 15-100	$0 days 1-14 $95 days 15-100
Durable Medical Equipment	20%	20%	20%	20%

For a detailed 2009 Summary of Benefits for plans with Part D Prescription Drug coverage click on the link.

For a detailed 2009 Summary of Benefits for medical-only plans, click on the link.

For the 2009 Evidence of Coverage, click on the link.

Information is current as of 05/18/10. Please call to confirm you have the most up to date information about our Medicare Plans. Click here for a full list of Medicare Disclaimers.

S5860_H0602_1307017 MC150WEB Pending CMS Approval 08312010.