The Health Plan SecureCare Integrity Plan 1 (HMO) is a Medicare Advantage (Part C) Plan by The Health Plan.
This page features plan details for 2024 The Health Plan SecureCare Integrity Plan 1 (HMO) H3672 – 021 – 0 available in Southeastern OH, West Virginia.
IMPORTANT: This page has been updated with plan and premium data for 2024.
The Health Plan SecureCare Integrity Plan 1 (HMO) is offered in the following locations.
The Health Plan SecureCare Integrity Plan 1 (HMO) offers the following coverage and cost-sharing.
Insurer: | The Health Plan |
Health Plan Deductible: | $0.00 |
MOOP: | $5,900 In-network |
Drugs Covered: | No |
Ready to sign up for The Health Plan SecureCare Integrity Plan 1 (HMO) ?
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $0.00 | $0.00 | $174.70 |
The Health Plan SecureCare Integrity Plan 1 (HMO) also provides the following benefits.
$0 |
In-network | No |
$5,900 In-network |
Yes |
In-network | No |
$0-250 copay per visit (Authorization is required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $35 copay per visit (Authorization is required.) (Referral is not required.) |
$0 copay (Authorization is required.) (Referral is not required.) |
Emergency | $110 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $50 copay (Authorization is not required.) (Referral is not required.) |
Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
Diagnostic radiology services (e.g., MRI) | $0-150 copay (Authorization is required.) (Referral is not required.) |
Outpatient x-rays | $50 copay (Authorization is required.) (Referral is not required.) |
Hearing exam | $35 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
Hearing aids | $599-899 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Restorative services | 0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Endodontics | 0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Periodontics | 0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Extractions | 0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | 0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
$250 copay (Not applicable.) (Not applicable.) |
$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Foot exams and treatment | $35 copay (Authorization is required.) (Referral is not required.) |
Routine foot care | $35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
$295 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $295 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $35 copay (Authorization is required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $35 copay (Authorization is required.) (Referral is not required.) |
Outpatient group therapy visit | $35 copay (Authorization is required.) (Referral is not required.) |
Outpatient individual therapy visit | $35 copay (Authorization is required.) (Referral is not required.) |
$0 per day for days 1 through 20 $150 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
Monthly Premium | $17.20 |
Deductible | nan |
Ready to sign up for The Health Plan SecureCare Integrity Plan 1 (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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