2021 Biweekly rates for zip code
- Hmo Copayment Requirements
- Hmo Copay Medicaid
- Aetna Hmo Copay
- Hmo Copay For Doctor Visit
- La Care Silver 87 Hmo Copay
- Benefits Of Hmo Plans
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
What is a copay? A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay. Humana Gold Plus H4461-036 (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. 50% up to $200 maximum. For specialty drug information, see the federal plan brochure. Your plan requires the use of generic medication when a generic equivalent exists. Or get a 90-day supply for $20 for generics, 50% up to $400 max for brand name, 50% up to $600 max for nonformulary. Built-in Vision.
Table of rates.| Aetna Open Access® HMO Plan | Code | Non-Postal | Postal 1 | Postal 2 |
|---|
Click to learn more about non-postal, postal 1 and postal 2 rates
Your 2021 benefits - DC, MD, Northern VA
A Health Maintenance Organization (HMO) health plan offers a local network of doctors and hospitals for you to choose from. Each HMO plan includes global emergency and urgent care coverage. 24 hours a day, seven days a week. If you choose a Cigna HMO or Cigna HMO Point of Service plan, it’s important to know the key features of both plans. Outpatient surgery copay: $750: Emergency room copay: $250: Urgent care center copay: $100: Lab/X-ray/diagnostic services: $15 PCP / $35 specialist ($75 for certain tests) Prescription drug copays (for a 30-day supply at a retail pharmacy) Generic formulary. $5: Brand-name formulary. $35: Non-formulary. $100: For specialty drug information, see.
Table of rates.| Plan Details | Basic Option |
|---|
| Preventive care copay | $0 |
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| Primary care visit copay | $25 |
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| Specialist visit copay | $55 |
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| Maternity | You pay 20% |
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| Prenatal Care | $0 |
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| Hospital Care | You pay 20% |
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| Inpatient hospital copay | You pay 20% |
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| Outpatient surgery copay | $350 |
|---|
| Emergency room copay | $200 |
|---|
| Urgent care center copay | $50 |
|---|
| Lab/X-ray/diagnostic services | $25 PCP / $55 specialist ($100 for certain tests) |
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Prescription drug copays
(for a 30-day supply at a retail pharmacy) |
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| Generic formulary* | $10 |
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| Brand-name formulary* | 50% up to $200 maximum |
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| Non-formulary* | 50% up to $300 |
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For specialty drug information, see the federal plan brochure.
Your plan requires the use of generic medication when a generic equivalent exists. ***
Or get a 90-day supply for $20 for generics, 50% up to $400 max for brand name, 50% up to $600 max for nonformulary. |
| Built-in Vision |
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| Routine eye exam copay | $55 |
|---|
| Money toward prescription eyewear | You get $100 every 24 months |
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| Discounts on eyeglasses, contacts, eye exams and more | Included |
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Built-in dental, too
Use our Basic Dental Network. Call 1-800-537-9384 to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice!
Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD).
PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.**
- Large nationwide Aetna Network
- 24/7 access to doctors via phone or video with Teladoc®†
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists*
- Discounts on eyewear, LASIK surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
*** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
†Teladoc® is covered at the member cost share.
] Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Discount programs are neither offered nor guaranteed under our contract with the FEHB Program, but are made available to all enrollees and their families who become members under an Aetna Health Insurance Plan. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. Information is believed to be accurate as of the production date; however, it is subject to change.
Postal and Non-Postal rates
- Non-Postal rates apply to most non-Postal employees.
- Postal rates apply to United States Postal Service employees.
- Postal Category 1 rates apply to career bargaining unit employees represented by the APWU, IT/AS, NALC and NPMHU.
- Postal Category 2 rates apply to career bargaining unit employees represented by the PPOA.
- Non-Postal rates apply to all career non-bargaining unit Postal Service employees and career employees represented by the NRLCA agreement.
Jump to:
BlueJourney Essential (HMO) H3962-007 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Keystone Health Plan Central, Inc available to residents in Pennsylvania. This plan includes additional Medicare prescription drug (Part-D) coverage. The BlueJourney Essential (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.
BlueJourney Essential (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Keystone Health Plan Central, Inc works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueJourney Essential (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Keystone Health Plan Central, Inc and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Keystone Health Plan Central, Inc except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
Hmo Copayment Requirements
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST
2021 Keystone Health Plan Central, Inc Medicare Advantage Plan Costs
| Name: |
|---|
| Plan ID: | H3962-007 |
|---|
| Provider: | Keystone Health Plan Central, Inc |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $6,700 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $0 |
|---|
| Tiers with No Deductible: | 0 |
|---|
| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H3962-001 |
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BlueJourney Essential (HMO) Part-C Premium
Keystone Health Plan Central, Inc plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H3962-007 Part-D Deductible and Premium
BlueJourney Essential (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Keystone Health Plan Central, Inc plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Keystone Health Plan Central, Inc above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Keystone Health Plan Central, Inc Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Keystone Health Plan Central, Inc plan does not offer additional coverage through the gap.
H3962-007 Formulary or Drug Coverage
Hmo Copay Medicaid
BlueJourney Essential (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 BlueJourney Essential (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
|---|
| Endodontics | 50% coinsurance |
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| Extractions | 50% coinsurance |
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| Non-routine services | 50% coinsurance |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance |
|---|
| Restorative services | 50% coinsurance |
|---|
Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $250 copay |
|---|
| Diagnostic tests and procedures | $20 copay |
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| Lab services | $10 copay |
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| Outpatient x-rays | $50 copay |
|---|
Aetna Hmo Copay
Doctor Visits
| Primary | $5 copay per visit |
|---|
| Specialist | $30 copay per visit |
|---|
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $40 copay per visit (always covered) |
|---|
Foot Care (podiatry services)
| Foot exams and treatment | $30 copay |
|---|
| Routine foot care | Not covered |
|---|
Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
|---|
| Hearing aids | $0 copay |
|---|
| Hearing exam | $30 copay |
|---|
Inpatient Hospital Coverage
$190 per day for days 1 through 8
$0 per day for days 9 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $190 per day for days 1 through 8
$0 per day for days 9 through 90 |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
|---|
| Outpatient individual therapy visit | $40 copay |
|---|
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
|---|
Hmo Copay For Doctor Visit
MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
| Cleaning | Covered under office visit |
|---|
| Dental x-ray(s) | Covered under office visit |
|---|
| Fluoride treatment | Not covered |
|---|
| Office visit | $10.00 |
|---|
| Oral exam | Covered under office visit |
|---|
Rehabilitation Services
| Occupational therapy visit | $30 copay |
|---|
| Physical therapy and speech and language therapy visit | $30 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$178 per day for days 21 through 100 |
|---|
Transportation
Vision
| Contact lenses | $0 copay |
|---|
| Eyeglass frames | $0 copay |
|---|
| Eyeglass lenses | $0 copay |
|---|
| Eyeglasses (frames and lenses) | Not covered |
|---|
| Other | Not covered |
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| Routine eye exam | $20 copay |
|---|
| Upgrades | Not covered |
|---|
Wellness Programs (e.g. fitness nursing hotline)
Reviews for BlueJourney Essential (HMO) H3962
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
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| Colorectal Cancer Screening |
|---|
| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
|---|
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
|---|
| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in BlueJourney Essential (HMO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
|---|
| Members Leaving the Plan |
|---|
| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Health Plan Customer Service Rating for BlueJourney Essential (HMO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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BlueJourney Essential (HMO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
|---|
| Appeals Auto |
|---|
| Appeals Upheld |
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La Care Silver 87 Hmo Copay
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
|---|
| Statin with Diabetes |
|---|
Ready to Enroll?
Benefits Of Hmo Plans
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for BlueJourney Essential (HMO)
(Click county to compare all available Advantage plans)
| State: | Pennsylvania
|
|---|
| County: | Adams,Berks,Centre,Columbia,Cumberland,
Dauphin,Franklin,Fulton,Juniata,
Lancaster,Lebanon,Lehigh,Mifflin,
Montour,Northampton,Northumberland,Perry,
Schuylkill,Snyder,Union,York,
|
|---|
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.