SCAN has a contract with the Federal Government. SCAN is a Medicare Advantage Prescription Drug Plan
(MAPD) offered by SCAN Health Plan, which is an HMO with Medicare Advantage contracts. Co-payments
apply for most services. Limitations and Exclusions may apply. H5425_SCAN_3857_2008_CMS101708
| Benefits & Services In Network |
Classic |
| Monthly Plan Premium |
$0 per month |
| Doctor Office Visits |
| Ventura: |
$10 copay per PCP
$10 copay per Specialist
|
| Kern: |
$5 copay per PCP
$10 copay per Specialist
|
|
| Inpatient Hospital Care |
$100 copay: days 1 - 4 |
| Skilled Nursing Facility |
$0 copay: days 1 - 20
$20 copay: days 21 - 100 |
| Emergency Care Worldwide Coverage |
$50 each visit |
| Outpatient Surgery |
$100 each visit |
| Ambulance |
$100 copay |
| Transportation (limitations apply) |
$0 copay |
| Vision Services |
$10 copay for annual exam
$25 copay for glasses/contacts every two years
Coverage toward eyewear: $75 frames / $100 contacts
|
| Hearing Aid Services |
$10 copay for exam
$0 - $10 copay for hearing aid fitting/evaluation
$400 limit for hearing aids every three years
|
| Diagnostic Tests, X-Rays and Lab Services |
$0 copay |
| Medical Supplies & Equipment |
0% to 10% of cost for Medicare covered items. |
| Routine Physical Exam |
$0 copay |
| Urgent Care |
| Ventura: |
$10 - $25 copay |
| Kern: |
$5 - $25 copay |
|
| Healthwise® For Life Handbook |
Included |
| SCAN Club Newsletter |
Included |
| Friends and Family Program |
Available |
| SCAN OnCall® 24 Hour Nurse Line |
Available |
| SCAN Senior Resource Center |
Located in Ventura
For More Information Call
(805) 658-0365
Monday - Friday, 9am - 4 pm
|
SCAN offers unique in-home services to facilitate recovery from an illness or injury. Coverage is provided up to $1,000 per calendar year. Authorization rules apply. Contact SCAN for details.
| Benefits & Services In Network |
Classic |
| Home Delivered Meals |
You pay $0 |
| Personal Care |
You pay $15 per visit |
| Transportation Escort |
You pay $15 per visit |
| In-Home Recovery Benefit Coordinator |
You pay $0 |
| Custodial Level Care |
You pay $0 |
| Benefits & Services In Network |
Classic |
SCAN Contracted Pharmacy
1-month/31-Day
Supply of Drugs
|
$0 copay for Select Generic Drugs
$10 copay for Preferred Generic Drugs
$30 copay for Brand Drugs
$50 copay for Additional Brand Drugs
25% copay for Specialty Drugs
|
SCAN Mail Order Service
3-month/90-Day
Supply of Drugs
|
$0 copay for Select Generic Drugs
$20 copay for Preferred Generic Drugs
$60 copay for Brand Drugs
$100 copay for Additional Brand Drugs
|
| Coverage Limits |
KERN:
$2,800 in Total Drug Costs
After $2,800 Formulary Generic Drugs Covered
Copays Apply
Brand Drugs Not Covered
VENTURA:
$3,000 in Total Drug Costs
After $3,000 Formulary Generic Drugs Covered
Copays Apply
Brand Drugs Not Covered
|