X hits on this document

PDF document

Providence Health Plan is a health plan with a Medicare contract. - page 6 / 32

118 views

0 shares

0 downloads

0 comments

6 / 32

SUMMARY OF BENEFITS

If you have any questions about this plan’s benefits or costs, please contact Providence Health Plan.

Benefit Category INPATIENT CARE 3 - Inpatient Hospital Care

(includes Substance Abuse and Rehabilitation Services)

Original Medicare

In 2010 the amounts for each benefit period were: Days 1 – 60: $1,100 deductible Days 61 – 90: $275 per day Days 91 – 150: $550 per lifetime reserve day

These amounts will change for 2011.

Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days.

Lifetime reserve days can only be used once.

Providence Medicare Extra + RX

In-Network

No limit to the number of days covered by the plan each benefit period.

For Medicare-covered hospital stays:

Days 1 – 6: $100 copay per day Days 7 – 90: $0 copay per day

$0 copay for each additional hospital day.

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.

A "benefit period" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

4 - Inpatient Mental Health Care

Same deductible and copay as inpatient hospital care (see "Inpatient Hospital Care" above).

190 day lifetime limit in a Psychiatric Hospital.

In-Network

You get up to 190 days in a Psychiatric Hospital in a lifetime.

For Medicare-covered hospital stays:

Days 1 – 6: $100 copay per day Days 7 – 90: $0 copay per day

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.

6

Document info
Document views118
Page views118
Page last viewedMon Jan 23 15:06:38 UTC 2017
Pages32
Paragraphs574
Words8210

Comments