freedom sales presentation
TRANSCRIPT
H5427_16PLOV_CMS Approved
FRH16PLANOVER
Medicare Advantage Plan Information
Plan Overview
2
Table of Contents ............................................................2
Important Disclaimers .....................................................3
Plan Presentation ..........................................................4
Medicare Advantage Basics .............................................5
Why Choose Freedom Health? ..........................................6
More Benefits & More Savings .........................................7
Visit Our Concierge Office ................................................8
Preventive Services .........................................................9
Formulary Information ...................................................10
Prescription Drugs ........................................................11
Your Medical Home .......................................................12
Freedom Health Plans ...................................................13
Enrollment ...................................................................14
What to Expect After You Enroll .....................................15
Your Freedom ID Card ...................................................16
Benefit Overview ...........................................................17
Plan Finder ..............................................................18-19
Plan Benefits ...........................................................20-27
How to Use Your Benefits and Services ......................28-33
Member Portal .............................................................34
Maximum Out of Pocket (MOOP) ....................................35
How to Enroll ................................................................36
Over-the-Counter Health Related Supplies ..................37-39
Questions ....................................................................40
Table of Contents
33
Freedom Health is an HMO plan with a Medicare contract and a contract with the Florida Medicaid program. Enrollment in Freedom Health depends on contract renewal.
This information is not a complete description of benefits. Contact the plan for more information.
Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
You must continue to pay your Medicare Part B premium. Limitations, co-payments and restrictions may apply. Benefit amounts may vary based on plan and county.
The Part B premium is covered for full dual members of Special Needs Plans.
Our dual eligible Special Needs plans are available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help that you receive.
Our chronic condition Special Needs plan is available to anyone with Medicare who has been diagnosed with Diabetes, Cardiovascular Disease, Chronic Heart Failure, or Chronic Obstructive Pulmonary Disease (COPD).
Freedom Health is accredited by the National Committee for Quality Assurance. NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system --physicians, hospitals, other providers and administrative services -- in order to continuously improve the quality of care and services provided to its members.
Freedom Health has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (SNP) until 2018 based on a review of Freedom Health’s Model of Care.
A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings call 1-888-796-0946, TTY: 711.
HMO eligible beneficiaries may enroll in the plan only during specific times of the year. HMO-SNP eligible beneficiaries can enroll at any time.
Contact the Plan for more information at the number listed on the back page.
Important Dates each year
October 1:
Oct 15 – Dec 7:
Important Disclaimers
4
Name of Benefit Consultant: _________________________
Prospective Members: please write the name of the plan representative with whom you are meeting.
This Presentation will cover Freedom Health’s Medicare Advantage HMO Plans and Medicare Advantage HMO Special Needs Plans and will highlight the following information:
Your Current Medicare Coverage
Comparing Medicare Advantage to Original Medicare
Freedom’s Benefit Plan Options
Choosing the Best Plan for You
How to Enroll in a Freedom Health Medicare Advantage HMO Plan or HMO-SNP Plan
Plan Presentation
5
What is Medicare?
Medicare is federal health insurance for:
people 65 and older,
younger people with certain disabilities, and
people with end-stage renal disease (with limited exceptions).
Medicare Advantage Basics - Are you Eligible?
You must have both Medicare parts “A” and “B”.
You must be a permanent resident in the area where the plan is offered.
People with End Stage Renal Disease are not eligible for Medicare Advantage (with limited exceptions).
6
Why Ch�se Freedom Health?
Freedom Health is...
Owned and operated by doctors
Focused on preventive care
Headquartered in Tampa, FL
Accredited by NCQA with a “Commendable” rating.
An HMO plan with a Medicare contract and a contract with the Florida Medicaid program.
4.0 Overall Medicare Star Rating*
1
2
3
4
5
6
7
More Benefits + More Savings = Better Value!
Here are some of the best reasons to join!
Receive a monthly over-the-counter allowance from $10 to $45 each month based on plan selection. That’s a savings between $120 and $540 over the course of a year! Easy online ordering or phone your order in! Your order is shipped to you at no cost.
Get a SilverSneakers® Fitness Membership at no cost to you! With access to thousands of locations, you will have use of the equipment, pools, saunas and other amenities. You can also order a SilverSneakers® Steps home fitness kit if that is more convenient!
Save with a Part B premium refund on select plans. That’s a savings between $36 to $80 each month or between $432 to $960 over the course of a year applied back to your social security check!
Valuable Vision, Dental and Hearing benefits.
Receive between 4 and 12 one way Transportation trips on our Freedom Medicare, Platinum or Chronic SNP plans depending on the plan. Our Dual SNP plans offer 12 round transportation trips.
Stay healthier with an array of Preventive Services at NO COST to YOU! Receive an Annual Wellness Visit, screenings, vaccines and many other services to keep you on track.
Brand and Generic prescription drug coverage is available on plans that offer part “D” coverage. Gap coverage is available on select plans.
With our home delivery pharmacy, you will receive 3 months supply for 2 months copay on most plans with prescription drug coverage. Easy ordering and delivery within 10 days. You can also sign up for automated mail order delivery.
8
Visit our Concierge Offices
Hillsborough/Pinellas/Polk5403 N. Church Ave., Tampa Toll Free: 1-888-211-9918
Indian River/Martin/St. Lucie1187 S. US Hwy. 1, Vero BeachToll Free: 1-888-274-8575
Lake/Marion/Sumter/Volusia2102 SW 20th Pl.,Building 200, Suite 201, Ocala Toll Free: 1-888-420-2539
www.freedomhealth.com.
Brevard/Orange/Osceola/Seminole950 S. Winter Park Dr., Suite 340, CasselberryToll Free: 1-888-364-7905
Charlotte/Manatee/Sarasota3874 E. SR 64, Bradenton Toll Free: 1-888-850-5315
Citrus/Hernando/Pasco8373 Northcliffe Blvd., Spring Hill Toll Free: 1-888-211-9921
Collier/Lee6831 Palisades Park Ct., Suite 1, Ft. Myers Toll Free: 1-888-272-2992
Our Local Concierge Centers Offer:
(replacement cards, PCP changes, etc.)
Member Services: TTY: 711
Healthcare is local – whether it’s your doctor, your specialist, or your insurance provider. We’re headquartered in Tampa, Florida with local concierge centers throughout the State.
Visit or Call Us at a Location Near You Concierge Hours of Operation: 8am - 5pm,
Monday - Friday
9
Preventive Services
cost to you:
$0Screening
Training
10
Formulary Information
The plan has four (4) cost-sharing tiers. Every drug on the plan’s Drug List is in one of four cost-sharing tiers. To find out which cost-sharing tier your drug is in, look it up in the plan’s Formulary. Then refer to the benefits section for plan-specific cost-sharing.
How do you find your drugs in the Formulary?There are two ways to find your drug within the formulary:
1) Alphabetical Listing The Index of the Formulary provides an alphabetical list of all
of the drugs along with the page number where you can find coverage information.
2) Medical Condition Drugs in the formulary are grouped into categories depending
on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category “Cardiovascular Agents”.
Initial Coverage Stage Drug Costs
Formulary(List of Covered Drugs)
PBP Plan Name078 Freedom Medi-Medi Partial (HMO SNP)087 Freedom Medi-Medi Full (HMO SNP)
11
Prescription Drugs
How Much Do You Pay for Prescription Drugs?
Stage 3Catastrophic
Coverage Stage
Once you have paid enough for your drugs to move onto this last payment stage, the plan will pay most of the cost of your drugs for the rest of the year.(2)
Stage 1Initial Coverage Stage
The plan pays its share of the cost of your drugs and you pay your share of the cost.
You stay in this stage until your payments for the year plus the plan’s payments total $3,310.
Stage 2Coverage Gap Stage/
Donut Hole
You pay 58% of the generic drug cost and the discounted cost for brand drugs until the yearly out-of-pocket drug cost reaches $4,850, unless you are already getting Medicare Extra Help.(1)
12
Your Network Primary Care Provider (PCP) coordinates all of your care. A network PCP is considered your “medical home”.
Benefits of a Medical Home
Your Medical Home
Hospital
Ancillary
DME Supplies Pharmacy
Wellness Services
Network Specialist
Network PCP
Freedom Health Plans
The Freedom Health Medicare Advantage HMO are plans with and without prescription drug coverage that offer many valuable benefits.
Freedom Health also offers two types of Special Needs Plans (SNPs). If you qualify to join a Medicare SNP, you get all of your Medicare hospital and medical health care services through the plan, including Medicare prescription drug coverage:
with drug coverage are plans available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive.
with drug coverage are plans for those individuals who have been diagnosed with chronic or disabling conditions such as:
Freedom Health has a plan for you!
- Cardiac Arythmias
- Coronary Artery Disease
- Peripheral Vascular Disease
- Chronic Venous Thromboembolic Disorder
- COPD
- Bronchitis
- Asthma
- Pulmonary Fibrosis
13
14
Enrollment
eligible individuals may enroll or end their enrollment in a MA plan. The AEP occurs October 15th through December 7th of each year.
following January 1st of each year.
the year.
may be able to enroll with an earlier effective date.
Please call our Member Services department for more information or refer to the “Medicare & You” handbook for more information on enrollment periods. You can review this handbook on the web by visiting: www.medicare.gov/publications/
15
What to Expect After You Enroll
You will receive a Freedom Health welcome packet and other plan materials that include:
(Material covers may vary)
FRH12KITENV
P.O. Box 151137, Tampa, FL 33684
www.freedomhealth.com
Address Service Requested
2015Evidence of Coverage
5ge
2015 Provider and Pharmacy Directory
Formulary(List of Covered Drugs) PBP Plan Name078 Freedom Medi-Medi Partial (HMO SNP)
087 Freedom Medi-Medi Full (HMO SNP)
ID: <0000000000> <0000>
<FIRST><MI><LAST>
Eff. Date: <Insert date>PCP: <John Doe, M.D.>Phone: <555-555-5555>
RxBIN#: 610011 RxPCN#: IRXRxGrp#: MPDH5427 Issuer#: 80840RxID#: <Insert member ID#>
Member Since
H5427 – PBP<number>
SAMPLE00000000> <0
T><MI <LAST>
M
16
ID: <0000000000> <0000>
<FIRST><MI><LAST>
Eff. Date: <Insert date>PCP: <John Doe, M.D.>Phone: <555-555-5555>
RxBIN#: 610011 RxPCN#: FRHRxGrp#: MPDH5427 Issuer#: 80840RxID#: <Insert member ID#>
Member Since
H5427 – PBP<number>
Identifies your plan benefits for your pharmacist
Your Freedom identification number
The year you joined Freedom Health
Name of your Freedom Medicare Advantage Plan
Your Plan Number
Up-front payments for the plan benefits you
receive
Member Services Toll-Free Number
Information for your doctor, pharmacist or
hospital
<Freedom Plan Name>
Member Services: 1-800-401-2740TTY/TDD: 1-800-955-8771 www.freedomhealth.com
Behavioral Health: <X-XXX-XXX-XXXX>Provider Services (UM): <X-XXX-XXX-XXXX>Pharmacy Technical Support: <X-XXX-XXX-XXXX>Part D Prior Authorization: <X-XXX-XXX-XXXX>
Submit Claims to: Freedom Health Claims DepartmentP.O. Box 151348Tampa FL 33684EDI Payer ID: XXXXX
Urgent Care: <$>ER: <$>
Your Freedom ID Card
SAMP00000000T><MI><LAST>AMPLE0000> <
SAMPPLEP
SAMPLE: 1-800-401-271-800-955-877 www.freedomh
lth: XXASAMPLSA
17
Our Representative will show you the specifics of your Freedom Health Medicare
Advantage plan benefits, using the Plan Overview and the 2016 Formulary.
2016 Benefits
Benefit Overview
18
Plan Type MAPD
Plan Name Freedom Medicare Plan Rx Freedom Platinum Plan Rx Freedom VIP Care
F
HMO HMO HMO-SNPPlan ID#County
059 060 088 089 091 092 093 094 070
Brevard X
Broward X
Charlotte X
Citrus X X X
CollierHernando X X
Hillsborough X X
Indian River X X
Lake X X X
Lee X
Manatee X X X
Marion X X X
Martin X
Miami-Dade X X
Orange X X X
Osceola X X X
Palm Beach X X
Pasco X X
Pinellas X X
Polk X X
Sarasota X X
Seminole X X X
St. Lucie X X
Sumter X X X
Volusia X
Plan Finder Chart
19
Find a plan in your county
CSNP MA DSNPP Freedom VIP
SavingsFreedom VIP
Savings COPDFreedom VIP
SavingsFreedom VIP
Savings COPDFreedom Savings
PlanFreedom
Medi-Medi PartialFreedom
Medi-Medi FullHMO-SNP HMO-SNP HMO-SNP HMO-SNP HMO HMO-SNP
072 077 082 083 052 078 087
X X X X
X X X X
X X X X
X X X X X
X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X
X X X X X
X X X X X
X X X X X
X X X X X
X X X X X
20
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6-2
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150
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21-
100
$0 d
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1-5
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6-2
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22
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ays
21-1
00
$0 d
ays
1-5
$40
days
6-2
0$1
25 d
ays
21-1
00
$0 d
ays
1-5
$40
days
6-2
0$1
00 d
ays
21-1
00OU
TPAT
IENT
CAR
EPr
imar
y Ca
re V
isit
$0
$0
$0
$0
$0
Spec
ialis
t Visi
t$3
0 $3
5 $3
5 $3
0 $2
5 Ch
iropr
acto
r Visi
t$2
0 $2
0 $2
0 $2
0 $2
0 Po
diat
ry V
isit
$30
$35
$35
$30
$25
Out
patie
nt M
enta
l Hea
lth$3
0 $3
5 $3
5 $3
0 $2
5 O
utpa
tient
Sub
stan
ce A
buse
$30-
$200
$35-
$250
$35-
$200
$30-
$200
$25-
$200
Ambu
lato
ry S
urge
ry C
ente
r Visi
t$2
5 $5
0 $5
0 $2
5 $2
5 O
utpa
tient
Hos
pita
l Visi
t$2
00
$250
$2
00
$200
$2
00
Ambu
lanc
e$1
75
$195
$1
75
$175
$1
55
Emer
genc
y Ca
re$7
5 $7
5 $7
5 $7
5 $7
5 W
orld
wide
ER
Care
$500
cop
ay; $
25,0
00 li
mit
$500
cop
ay; $
25,0
00 li
mit
$500
cop
ay; $
25,0
00 li
mit
$500
cop
ay; $
25,0
00 li
mit
$500
cop
ay; $
25,0
00 li
mit
Urge
ntly
Need
ed C
are
$10
$10
$10
$10
$10
Occ
upat
iona
l The
rapy
$30
$35
$35
$30
$25
Phys
ical T
hera
py$3
0 $3
5 $3
5 $3
0 $2
5 Sp
eech
The
rapy
$30
$35
$35
$30
$25
Hom
e He
alth
$10
$10
$10
$10
$10
OUTP
ATIE
NT M
EDIC
AL S
ERVI
CES
AND
SUPP
LIES
Dura
ble M
edica
l Equ
ipmen
t (DM
E)20
%20
%20
%20
%20
%Pr
osth
etic
Devic
es20
%20
%20
%20
%20
%Di
abet
es M
onito
ring
Trai
ning
$0
$0
$0
$0
$0
Diab
etes
Nut
ritio
n Th
erap
y$0
$0
$0
$0
$0
Di
abet
es S
uppl
ies
0-20
%0-
20%
0-20
%0-
20%
0-20
%La
bora
tory
(Out
patie
nt)
$0
$0
$0
$0
$0
Diag
nost
ic Pr
oced
ures
/Tes
ts$0
$0
$0
$0
$0
X-
rays
$0
$0
$0
$0
$0
Diag
nost
ic Ra
diol
ogy
$25-
$150
$25-
$150
$25-
$150
$25-
$150
$25-
$150
Ther
apeu
tic R
adio
logy
20%
20%
20%
20%
20%
PREV
ENTI
VE S
ERVI
CES
Bone
Mas
s M
easu
rem
ent
$0
$0
$0
$0
$0
Colo
rect
al S
cree
ning
$0
$0
$0
$0
$0
Flu
Vacc
ine
$0
$0
$0
$0
$0
Pneu
mon
ia V
accin
e$0
$0
$0
$0
$0
Free
dom
Platin
um Pl
an
RX (H
MO)
Free
dom
Platin
um Pl
an
RX (H
MO)
Free
dom
Platin
um Pl
an
RX (H
MO)
Free
dom
Platin
um Pl
an
RX (H
MO)
Free
dom
Platin
um Pl
an
RX (H
MO)
23
*You
pay
58%
of g
ener
ic d
rug
cost
and
dis
coun
ted
cost
for b
rand
dru
g un
til th
e ye
arly
out
-of-p
ocke
t dru
g co
st re
ache
s $4
,850
, unl
ess
you
are
alre
ady
getti
ng M
edic
are
Extra
H
elp.
Som
e pl
ans
have
$0
and
som
e pl
ans
have
$5
co-p
ay fo
r Tie
r 1 d
urin
g th
e C
over
age
Gap
/Don
ut H
ole.
**C
ost S
harin
g va
ries
base
d on
Med
icai
d st
atus
.
Hepa
titis
B Va
ccin
e$0
$0
$0
$0
$0
M
amm
ogra
ms
$0
$0
$0
$0
$0
Pap
Smea
rs/P
elvic
Exa
ms
$0
$0
$0
$0
$0
Pros
tate
Can
cer S
cree
ning
$0
$0
$0
$0
$0
Rena
l Dia
lysis
20%
20%
20%
20%
20%
ESRD
Nut
ritio
n Th
erap
y$0
$0
$0
$0
$0
An
nual
Wel
lnes
s Vi
sit$0
$0$0
$0$0
PART
B D
RUGS
Part
B Dr
ugs
(not
Che
mo)
20%
20%
20%
20%
20%
Part
B Ch
emo
Drug
s20
%20
%20
%20
%20
%PA
RT D
DRU
GSDe
duct
ible
$0
$0
$0
$0
$0
ICL
Lim
it$3
,310
$3
,310
$3
,310
$3
,310
$3
,310
Ti
er 1
Pre
ferre
d G
ener
ic$0
$0
$0
$0
$0
Ti
er 2
Pre
ferre
d Br
and
$35
$35
$30
$30
$30
Tier
3 N
on-P
refe
rred
Bran
d$8
5 $8
0 $8
0 $6
9 $8
0 Ti
er 4
Spe
cialty
33%
33%
33%
33%
33%
Mai
l Ord
er3
mon
ths
for 2
cop
ays
3 m
onth
s fo
r 2 c
opay
s3
mon
ths
for 2
cop
ays
3 m
onth
s fo
r 2 c
opay
s3
mon
ths
for 2
cop
ays
GAP
Cov
erag
e*Ti
er 1
Tier
1Ti
er 1
Tier
1Ti
er 1
DENT
ALM
edica
re-C
over
ed D
enta
l$0
$0
$0
$0
$0
O
ral E
xam
$0
1/yr
$0
1/yr
$0
1/yr
$0
1/yr
$0
1/yr
Rout
ine
Dent
al C
lean
ing
$0
2/yr
$0
2/yr
$0
2/yr
$0
2/yr
$0
2/yr
Fluo
ride
Trea
tmen
t$0
1/
yr$0
1/
yr$0
1/
yr$0
1/
yr$0
1/
yrDe
ntal
X-ra
y$5
-$75
$5-$
75$5
-$75
$5-$
75$5
-$75
Com
preh
ensiv
e De
ntal
No
No
No
No
No
HEAR
ING
Hear
ing
Aids
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
Hear
ing
Aid
Fitti
ng/E
val
$0
1 e
very
2 y
rs$0
1
eve
ry 2
yrs
$0
1 e
very
2 y
rs$0
1
eve
ry 2
yrs
$0
1 e
very
2 y
rsM
edica
re-C
over
ed H
earin
g$0
$0
$0
$0
$0
Ro
utin
e He
arin
g Ex
am$0
1
ever
y 2
yrs
$0
1 ev
ery
2 yr
s$0
1
ever
y 2
yrs
$0
1 ev
ery
2 yr
s$0
1
ever
y 2
yrs
VISI
ONG
lass
es/C
onta
cts
- Cat
Sur
g$1
5 $1
5 $1
5 $1
5 $1
5 Ro
utin
e Ey
e Ex
am$0
$0
$0
$0
$0
G
lass
es$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yrCo
ntac
ts$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yrEy
ewea
r Lim
it$1
00
$100
$1
00
$100
$1
00
SUPP
LEM
ENTA
L BE
NEFI
TSHe
alth
Clu
bY
esY
esY
esY
esY
esTr
ansp
orta
tion
$0 4
one
-way
trip
s$0
4 o
ne-w
ay tr
ips
$0 4
one
-way
trip
s$0
4 o
ne-w
ay tr
ips
$0 4
one
-way
trip
sOv
er-th
e-Co
unte
r (OT
C) S
uppli
es$3
5 $2
5 $2
5 $2
5 $3
0 N
oN
oN
oN
oN
o
24
PBP
Num
ber
070
072
077
082
083
Prem
ium
$0$0
$0$0
$0Pa
rt B
Buyd
own
$0.0
0$8
0.00
$61.
00$3
6.00
$0.0
0M
ax o
ut o
f Poc
ket
$3,4
00$3
,400
$3,4
00$6
,700
$6,7
00IN
PATI
ENT
CARE
Inpa
tient
Hos
pita
l$9
0 da
ys 1
-7$0
day
s 8-
90 $
205
days
1-7
$0
day
s 8-
90$1
95 d
ays
1-7
$0 d
ays
8-90
$250
day
s 1-
7$0
day
s 8-
90$2
50 d
ays
1-7
$0 d
ays
8-90
Inpa
tient
Men
tal
$90
days
1-7
$0 d
ays
8-90
$20
5 da
ys 1
-7
$0 d
ays
8-90
$195
day
s 1-
7$0
day
s 8-
90 $
250
days
1-6
$0 d
ays
7-90
$250
day
s 1-
6$0
day
s 7-
90Sk
illed
Nurs
ing
Facil
ity$0
day
s 1
-5$4
0 da
ys 6
-20
$125
day
s 21
-100
$0 d
ays
1-5
$40
days
6-2
0$1
50 d
ays
21-1
00
$0 d
ays
1-5
$40
days
6-2
0$1
50 d
ays
21-1
00
$0 d
ays
1-20
$15
0 da
ys 2
1-10
0$0
day
s 1-
20$1
50 d
ays
21-1
00
OUTP
ATIE
NT C
ARE
Prim
ary
Care
Visi
t$0
$0
$0
$0
$0
Sp
ecia
list V
isit
$25
$30
$30
$40
$45
Chiro
prac
tor V
isit
$20
$20
$20
$20
$20
Podi
atry
Visi
t$2
5 $3
0 $3
0 $4
0 $4
5 O
utpa
tient
Men
tal H
ealth
$25
$30
$30
$40
$40
Out
patie
nt S
ubst
ance
Abu
se$2
5-$2
00$3
0-$2
50 $
30-$
250
$40-
$250
$4
5-$2
50Am
bula
tory
Sur
gery
Cen
ter V
isit
$0
$50
$50
$100
$1
00
Out
patie
nt H
ospi
tal V
isit
$200
$2
50
$250
$2
50
$250
Am
bula
nce
$150
$1
75
$150
$1
50
$175
Em
erge
ncy
Care
$75
$75
$75
$75
$75
Wor
ldwi
de E
R Ca
re$5
00 c
opay
; $25
,000
lim
it$5
00 c
opay
; $25
,000
lim
it$5
00 c
opay
; $25
,000
lim
it$5
00 c
opay
; $25
,000
lim
it$5
00 c
opay
; $25
,000
lim
itUr
gent
ly Ne
eded
Car
e$1
0 $1
0 $1
0 $1
0 $1
0 O
ccup
atio
nal T
hera
py$2
5 $3
0 $3
0 $4
0 $4
0 Ph
ysica
l The
rapy
$25
$30
$30
$40
$40
Spee
ch T
hera
py$2
5 $3
0 $3
0 $4
0 $4
0 Ho
me
Heal
th$0
$0$0
$0$0
OUTP
ATIE
NT M
EDIC
AL S
ERVI
CES
AND
SUPP
LIES
Dura
ble M
edica
l Equ
ipmen
t (DM
E)20
%20
%0-
20%
*O
xyge
n $
020
%0-
20%
*O
xyge
n $
0Pr
osth
etic
Devic
es20
%20
%20
%20
%20
%Di
abet
es M
onito
ring
Trai
ning
$0
$0
$0
$0
$0
Diab
etes
Nut
ritio
n Th
erap
y$0
$0
$0
$0
$0
Di
abet
es S
uppl
ies
0%0%
0-20
%0%
0-20
%La
bora
tory
(Out
patie
nt)
$0
$0
$0
$0
$0
Diag
nost
ic Pr
oced
ures
/Tes
ts$0
$0
$0
$0
$0
X-
rays
$0
$0
$0
$0
$0
Diag
nost
ic Ra
diol
ogy
$25-
$125
$25-
$150
$25-
$150
$25
-$20
0 $
25-$
200
Ther
apeu
tic R
adio
logy
20%
20%
20%
20%
20%
PREV
ENTI
VE S
ERVI
CES
Bone
Mas
s M
easu
rem
ent
$0
$0
$0
$0
$0
Colo
rect
al S
cree
ning
$0
$0
$0
$0
$0
Flu
Vacc
ine
$0
$0
$0
$0
$0
Pneu
mon
ia V
accin
e$0
$0
$0
$0
$0
Free
dom
VIP C
are
(HMO
-SNP
) Fr
eedo
m VIP
Savin
gs
(HMO
-SNP
)Fre
edom
VIP S
aving
s COP
D (HM
O-SN
P)Fr
eedo
m VIP
Savin
gs
(HMO
-SNP
)Fre
edom
VIP S
aving
s COP
D (HM
O-SN
P)
25
*You
pay
58%
of g
ener
ic d
rug
cost
and
dis
coun
ted
cost
for b
rand
dru
g un
til th
e ye
arly
out
-of-p
ocke
t dru
g co
st re
ache
s $4
,850
, unl
ess
you
are
alre
ady
getti
ng M
edic
are
Extra
H
elp.
Som
e pl
ans
have
$0
and
som
e pl
ans
have
$5
co-p
ay fo
r Tie
r 1 d
urin
g th
e C
over
age
Gap
/Don
ut H
ole.
**C
ost S
harin
g va
ries
base
d on
Med
icai
d st
atus
.
Hepa
titis
B Va
ccin
e$0
$0
$0
$0
$0
M
amm
ogra
ms
$0
$0
$0
$0
$0
Pap
Smea
rs/P
elvic
Exa
ms
$0
$0
$0
$0
$0
Pros
tate
Can
cer S
cree
ning
$0
$0
$0
$0
$0
Rena
l Dia
lysis
20%
20%
20%
20%
20%
ESRD
Nut
ritio
n Th
erap
y$0
$0
$0
$0
$0
An
nual
Wel
lnes
s Vi
sit$0
$0$0
$0$0
PART
B D
RUGS
Part
B Dr
ugs
(not
Che
mo)
20%
20%
20%
20%
20%
Part
B Ch
emo
Drug
s20
%20
%20
%20
%20
%PA
RT D
DRU
GSDe
duct
ible
$0
$0
$0
$0
$0
ICL
Lim
it$3
,310
$3
,310
$3
,310
$3
,310
$3
,310
Ti
er 1
Pre
ferre
d G
ener
ic$0
$0
$0
$0
$0
Ti
er 2
Pre
ferre
d Br
and
$25
$35
$35
$40
$40
Tier
3 N
on-P
refe
rred
Bran
d$7
5 $8
0 $8
0 $9
0 $9
0 Ti
er 4
Spe
cialty
33%
33%
33%
33%
33%
Mai
l Ord
er3
mon
ths
for 2
cop
ays
3 m
onth
s fo
r 2 c
opay
s3
mon
ths
for 2
cop
ays
3 m
onth
s fo
r 2 c
opay
s3
mon
ths
for 2
cop
ays
GAP
Cov
erag
e*Ti
er 1
Tier
1 $
5Ti
er 1
$5
Tier
1 $
5Ti
er 1
$5
DENT
ALM
edica
re-C
over
ed D
enta
l$0
$0
$0
$0
$0
O
ral E
xam
$0
1/yr
$0
1/yr
$0
1/yr
$0
1/yr
$0
1/yr
Rout
ine
Dent
al C
lean
ing
$0
2/yr
$0
2/yr
$0
2/yr
$0
2/yr
$0
2/yr
Fluo
ride
Trea
tmen
t$0
1/
yr$0
1/
yr$0
1/
yr$0
1/
yr$0
1/
yrDe
ntal
X-ra
y$5
-$75
$5-$
75$5
-$75
$5-$
75$5
-$75
Com
preh
ensiv
e De
ntal
No
No
No
No
No
HEAR
ING
Hear
ing
Aids
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
$0 fo
r 1 a
id; 1
aid
/2yr
s$5
00 li
mit
Hear
ing
Aid
Fitti
ng/E
val
$0
1 e
very
2 y
rs$0
1
eve
ry 2
yrs
$0
1 e
very
2 y
rs$0
1
eve
ry 2
yrs
$0
1 e
very
2 y
rsM
edica
re-C
over
ed H
earin
g$0
$0
$0
$0
$0
Ro
utin
e He
arin
g Ex
am$0
1
ever
y 2
yrs
$0
1 ev
ery
2 yr
s$0
1
ever
y 2
yrs
$0
1 ev
ery
2 yr
s$0
1
ever
y 2
yrs
VISI
ONG
lass
es/C
onta
cts
- Cat
Sur
g$1
5 $1
5 $1
5 $1
5 $1
5 Ro
utin
e Ey
e Ex
am$0
$0
$0
$0
$0
G
lass
es$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yr$1
5 1/
yrCo
ntac
ts$1
5 1/
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27
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28
How to Use Your Benefits and Services
Member ServicesContact us at 1-800-401-2740. TTY users: 711, 8am - 8pm 7 days a week from Oct 1 - Feb 14 and 8am - 8pm Monday-Friday from Feb 15 - Sept 30.
ChiropracticFor Chiropractors, call our Member Services department or talk to your PCP for chiropractic questions.
Dental, Vision & Hearing
Freedom partners with Argus Dental for both Dental and Vision services. Please call Member Services for a provider listing, or review providers at www.argusdentalvision.com. Hearing services are provided by HearUSA. They can be contacted at 1-800-333-3389.
Freedom has partnered with SilverSneakers® to
all of our plans. Please visit their website at www.silversneakers.com or call our Member Services department for the most updated participating network
Please take your Freedom ID to the participating
Lab Services
Freedom Health partners with Quest Diagnostics to provide clinical laboratory services. Call them directly at 1-800-377-8448. TTY/TDD users call 711 or visit their website at www.questdiagnostics.com for a location near you.
Over-the-Counter Health Related Supplies
may contact us directly. A list of available suppliesare on page 37, along with ordering information. You will receive supplies in approximately 7-10 business days after you submit your order.
Podiatry
Participating podiatrists are listed in the Provider Directory. Call our Member Services department or talk to your PCP for podiatry questions.
Service How to Find It?
While you must stay within our network of providers, these companies were chosen through a
29
Using Your Plan: Vision Benefits
All of our plans also offer vision
after each cataract surgery that includes insertion of an intraocular lens. Corrective lenses/frames (and replacements) needed after cataract removal without a lens implant.
(continued on next page)
Vision Benefits
Freedom Savings Plan (HMO): 052
Freedom Medi-Medi Partial (HMO SNP): 078Freedom Medi-Medi Full (HMO SNP): 087
Freedom Medicare Plan Rx (HMO): 059, 060Freedom VIP Care (HMO SNP): 070Freedom VIP Savings (HMO SNP): 072, 082Freedom VIP Savings COPD (HMO SNP): 077, 083Freedom Platinum Plan Rx (HMO): 088, 089, 091, 092, 093, 094
Covered Services Co-Pays Co-Pays Co-Pays
Eye Exams
Vision Benefits
Freedom Savings Plan (HMO): 052
Freedom Medi-Medi Partial (HMO SNP): 078Freedom Medi-Medi Full (HMO SNP): 087
Freedom Medicare Plan Rx (HMO): 059, 060Freedom VIP Care (HMO SNP): 070Freedom VIP Savings (HMO SNP): 072, 082Freedom VIP Savings COPD (HMO SNP): 077, 083Freedom Platinum Plan Rx (HMO): 088, 089, 091, 092, 093, 094
Covered Services Co-Pays Co-Pays Co-Pays
(continued from previous page)
30
Dental Benefits
Freedom Savings Plan (HMO): 052
Freedom Medi-Medi Partial (HMO SNP): 078Freedom Medi-Medi Full (HMO SNP): 087
Freedom Medicare Plan Rx (HMO): 059, 060Freedom VIP Care (HMO SNP): 070Freedom VIP Savings (HMO SNP): 072, 082Freedom VIP Savings COPD (HMO SNP): 077, 083Freedom Platinum Plan Rx (HMO): 088, 089, 091, 092, 093, 094
Covered Services Co-Pays Co-Pays Co-Pays
(continued on next page)
(continued on next page)
continued on next page)
31
Using Your Plan: Dental Benefits
We all want a great smile, so all of our plans offer
include:
dental provider)
(excludes periodontal scaling, root planing and periodontal maintenance)
Dental Benefits
Freedom Savings Plan (HMO): 052
Freedom Medi-Medi Partial (HMO SNP): 078Freedom Medi-Medi Full (HMO SNP): 087
Freedom Medicare Plan Rx (HMO): 059, 060Freedom VIP Care (HMO SNP): 070Freedom VIP Savings HMO SNP): 072, 082Freedom VIP Savings COPD (HMO SNP): 077, 083Freedom Platinum Plan Rx (HMO): 088, 089, 091, 092, 093, 094
Covered Services Co-Pays Co-Pays Co-Pays
(Continued)
32
(continued from previous page)
33
Using Your Plan: Hearing Benefits
on most plans:
years.
years.
featuring choice of style and technologies.
Hearing BenefitsAll Plans
Covered Services Co-Pays
Diagnostic Hearing Exam
Routine Hearing Exam
Hearing Aids
Register & Do More Onlinewith our Member Portal!Here are some of the benefits you will receive:
Place & track orders for your over-the-counter medication and diabetic supplies.
Print and order your ID CARD, provider directory, formulary and other Plan materials.
View your claims
information.
Track your out-of-pocket expenses. (MOOP)
Personal Health Tracker
Find a Plan Doctor, Pharmacy, Hospital and covered drug.
Gain access to health & wellness information.
Access important Plan forms and documents from central location.
Complete your Health Assessment Form
NEW!
NEW!
34
35
Inpatient Services
Outpatient Services
Services
Services (OT, PT, & ST)
Outpatient Medical Services & Supplies
Training
Pneumonia)
Exams
The following services / benefits count towards your maximum out-of-pocket (MOOP). The MOOP amount for most 2016 Freedom Health Plans is $3,400.
Maximum Out Of Pocket Expenses
H
Record Your Important Information
Plan Name:
PBP Number:
Enrollment Application Number:
Effective Date:
Network PCP Name & Number:
Over-the-Counter Allowance per month:
How to Enroll:1. Have your Medicare ID or proof of eligibility ready before you begin the
application process.
2. You may complete the application on paper or through our website: www.freedomhealth.com.can help with any of these methods. If you need help, finding an agent, call our toll-free number.
3. Medicare beneficiaries may also enroll in Freedom Health through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
4. Choose a primary care physician. Use our Provider Directory to find
or go to our website at www.freedomhealth.com and from the Quick Links section, choose Provider Search.
5. Look up your prescriptions in our formulary booklet or go to our website and from the Quick Links section, choose the Drug Search.
36
More Supplies To Ch�se From!
or call:1-866-900-2688 TTY: 711
You receive medications by mail
32
We process your order
1Visit our website or call to place your order
37
Monthly Over-The-Counter Allowance - Benefits you can use everyday!
Log on to: www.freedomhealth.com
38
Save Time & Money in Over-the-Counter S
Item6I Generic Comparable of Chloraseptic6K Halls Sugar Free Cough Drops6L Generic Comparable of Mucus Relief 6M Generic Comparable of Cepacol
(7)7A Generic Comparable of Collyrium Eye Was7B Generic Comparable of Visine7C Generic Comparable of Visine Tears7E Generic Comparable of Zaditor
(8) First Aid Creams8A Generic Comparable of Benadryl Cream8B Generic Comparable of Bacitracin8C Generic Comparable of Lotrimin8D Generic Comparable of Cortisone8E Generic Comparable of Zinc Oxide8F Generic Comparable of Neosporin8G Generic Comparable of Micatin8H Generic Comparable of Debrox
(9) Firs9A Generic Comparable of Ace Bandage 3"9B9C Cotton Balls9D Ice Bag9E Generic Comparable of J&J Gauze9F Digital Themometer9G Generic Comparable of Q-Tips
(1010A Generic Comparable of Colace10B Generic Comparable of Fibercon10C Generic Comparable of Miralax10D Generic Comparable of Fleet Enema
(11) Misc11A Digital Blood Pressure Kit*11B Blood Pressure Kit *11C Generic Comparable of Band Aid11D Generic Comparable of Coppertone Sunscreen11E Generic Comparable of Dramamine
Item Item Description Qty. Price(1) Allergies
1A Generic Comparable of Chlortrimeton Chlorpheniramine Maleate 4mg 24 $41B Generic Comparable of Benadryl Elixir Diphenhydramine HCI 12.5 mg 118ml $3 1C Generic Comparable of Benadryl Caps Diphenhydramine HCI 25 mg 24 $31D Generic Comparable of Ocean Saline Nasal Spray Deep Sea Nasal Saline 0.65% 44ml $31E Nasacort Allergy 24 Hour 10.8 ml $151F Flonase Fluticasone propionate (glucocorticoid) 50mcg 9.9 ml $15
(2) Analgesics2A Generic Comparable of Tylenol Ex 500mg 100 $42B Generic Comparable of Bayer Aspirin Aspirin 325mg 100 $32C Generic Comparable of Zostrix 60g $72E Generic Comparable of Advil 24 $32F Generic Comparable of Ben Gay Muscle Rub 35g $32G Generic Comparable of Aleve Naproxen sodium 220 mg CPL 50 $72H Generic Comparable of Bayer Aspirin Low Dose 81 mg Aspirin EC (Delayed Release) 81 mg 120 $42I Generic Comparable of Tylenol PM Acetaminophen 500 mg/Diphenhydramine HCI 25 mg 50 $52J Generic Comparable of Bayer Aspirin Low Dose Chewable Aspirin 81 mg Chewable 36 $42K Generic Comparable of Icy Hot Patch Cold and Hot Patch 5 $82L Generic Comparable of Excedrin Headache Formula-Aspirin/Acetaminophen/Caffeine 100 $7
(3) Antacids3A Generic Comparable of Tums-Ex Calcium Carbonate 750 mg 96 $53B Generic Comparable of Gas-X 100 $53C Generic Comparable of Zantac 75 Ranitidine 75 mg 30 $93D Generic Comparable of Alka Seltzer Antacid & Pain Relief 12 $6
(4) Anti-Diarrheals 4A Generic Comparable of Imodium Loperamide 2 mg 12 $44B Generic Comparable of Pepto Bismol 30 $5
(5) Anti-Hemorrhoidals 5A Generic Comparable of Cortaid Maximum Strength Hydrocortisone oint, USP 1% 28g $65B Generic Comparable of Preparation H Prompt Relief Hem Ointment 57g $75C Generic Comparable of Preparation H Suppositories Hemorrhoidal Suppositories 12 $13
(6) Cough/Cold 6A Generic Comparable of Robitussin Sugar-free Dm Sugar-free cough syrup 118ml $56B Generic Comparable of Vicks Medicated Chest Rub 100g $66C Mucinex Dm Mucinex DM 600 mg 20 $206D Generic Comparable of Afrin nasal Spray Nasal Spray 15ml $36H Generic Comparable of Tylenol Sinus Congestion & Pain Sinus-Acetaminophen / Phenylephrine HCI 24 $5
*These items are considered dual purpose items. Prior to ordering these items, the enrollee must have an appropriate conversation with the enrollee’s p
DISCLAIMERS:1. OTC items may only be purchased for the enrollee; it is prohibited to purchase supplies
for family members, and friends. 2. The following supplies are not covered as they are non-eligible supplies: Alternative
Medicines (Includes botanicals, herbals, probiotics, homeopathic, and neutraceuticals), baby supplies, contraceptives, convenience & comfort supplies (insoles, gloves, etc.), cosmetics, food products or supplements, replacement & attachments such as contact lens containers or batteries.
3. To minimize mailing costs the plan may impose a limited ordering quantity per purchase.
4. This list is subject to change.
Orders will be shipped via UPS or USPS. Please allow 7-receive your order from the time the order is placed.
6. Please consult with your doctor before using any OTC pro7. All OTC supplies are generic comparable of Brand item. A
may be substituted for its Generic Comparable based on 8. All items are shipped based on manufacturer availability. 9. All items may not be available all the time. 10. If Generic Item is not acceptable, plan will not ship Brand
39
Supplies. Choose From the Following List:
Item Description Qty. PriceSore throat spray 177ml $5Sugar Free Cough Drops 25 $4Expectorant-Guaifenesin 400 mg 30 $7Cepacol 16 $5
(7) Eye Care e Wash Eye Wash 118ml $4
Redness Reliever Eye Drops 15ml $415ml $4
Eye-Itch Relief Antihistamine 5ml $15eams & Ointments & Antisepticsam Anti-Itch Cream 28g $3
Bacitracin 14g $6Clotrimazole 1% Cream 28g $7Hydrocortisone Cream 28g $5Zinc Oxide Ointment 28g $8
1oz $6Miconazole Nitrate 2% 28g $4Ear wax removal .5oz $4
) First Aid Suppliese 3" Elastic Bandage - 5 yards 1 $4
10 $2Cotton Balls 100 $4Ice Bag 9" 1 $9Gauze Rolls - Assorted sizes 3 $4
1 $5Cotton Swabs 300 $5
(10) LaxativesDocusate sodium 100 mg 100 $5Fiber-Lax 500 mg 60 $9Clear Lax Powder 119g $11Enema-Saline Laxative 133ml $3
Miscellaneous ItemsAutomatic Blood Pressure Kit 1 $29
1 $19Adhesive Bandage 50 $3
screen Lotion Sunscreen Lotion SPF-30 113g $1012 $4
Item Item Description Qty. Price11F Pill Organizer 1 $711G DEX4 Glucose Tablets 50 $811H Pill Splitter Pill Splitter 1 $511I Eye Glass Wipes 1 box $411J Estroven Multi-Symptom Menopause Relief 30 $20
(12) Topical Foot & Topical Oral12A Callus Remover Callus Removers 6 $412C Callus Cushion Callus Cushions 6 $312E Dental Flossers Dental Flossers 36 $312G Generic Comparable of Polident Denture Cleanser 40 $712H Toothpaste 2.7oz $412I Toothbrush 1 $312J Generic Comparable of Fixodent Denture Adhesives ADH CRM Fresh 1.4oz $5
(13) Vitamins & Minerals*13A Fish Oil Fish Oil - 1200 mg. 90 $913B Prosight Supplement for eyes 60 $613C Allbee With C B Complex with C 100 $813D Vitamin B B Complex 100 $813E Vitamin C Vitamin C Chewable 500 mg. 100 $813F Generic Comparable of Centrum Multivitamin & Mineral 60 $613G Folic Acid Folic Acid 800 mcg 100 $513H Glucosamine Chondroitin Glucosamine Chondroitin 60 $1513J Vitamin E Vitamin E 400 IU 100 $813K Vitamin D Vitamin D 1000 IU 100 $513L Antioxidant tablets 50 $713M Selenium Selenium 200 mcg 60 $713N Timed Release Niacin 60 $1013O Generic Comparable of Lactaid Tab Lactase Enzyme Supplement 50 $913P Ferrous Sulfate Ferrous Sulfate - 325 mg 100 $313Q Generic Comparable of Citracal Calcium Citrate Calcium Citrate & Vitamin D 60 $713R Generic Comparable of Bayer One A Day Women’s One A Day Women's Multivitamin 60 $1013S Generic Comparable of Os-Cal* Oyster Calcium + Vitamin D 100 $4
(14) Smoking Cessation14B Generic Comparable of Nicorette 4mg 50 $24
(15) Sleep-Aids15A Generic Comparable of Simply Sleep Sleep-tabs 25 mg 24 $415B Melatonin-Sleep Aid 60 $8
393939
Select from the items listed above and log on to: or call: 1-866-900-2688, TTY: 711
Freedom Health is an HMO plan with a Medicare contract and a contract with the Florida Medicaid program. Enrollment in Freedom Health, Inc. depends on contract renewal. This information is available for free in other languages. Please call our Member Service Department at 1-800-401-2740 for additional information. Hours are October 1 to February 14 from 8:00 am to 8:00 pm, 7 days a week and February 15 to September 30 from 8:00 am to 8:00 pm, Monday through Friday. TTY/TDD users should call 711.
Esta información está disponsible gratuitamente en otros idiomas. Por favor, llame a nuestro Departamento de Servicios al Miembro al 1-800-401-2740 para información adicional. Los usuarios de TTY deben llamar al 711. Nuestro horario es del 1ro de octubre hasta el 14 de febrero de 8 a.m. a 8 p.m., 7 días a la semana y del 15 de febrero hasta el 30 de septiembre de 8 a.m. a 8 p.m. de lunes a viernes.
ee’s personal provider who
ow 7-10 business days to
TC products. em. Any branded item d on availability.
bility.
Brand Name Item.
SWe’re making it easier to find answers. Try any of these four different ways:
1. Check the plan’s Evidence of Coverage 2. Visit a local Concierge Center 3. Go to www.freedomhealth.com
and search our website 4. Call Member Services
Still Have a Question?
Call Toll-Free: 1-800-401-2740 TTY: 7118 am to 8 pm 7 days a week from October 1 to February 148 am to 8 pm Monday through Friday from February 15 - September 30.
We’re making it eTry any of these
Check t
o find answersdifferent ways:
1. Check the plan’s Evidence of Co 2. Visit a local Concierge Center 3. Go to www.freedomh
and search our website 4. Call Member Service
Call Toll-Free: 1-8TTY: 7118 am to 8 pm 7 days a week from O8 am to 8 pm Monday through Frid
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To find out more details about our plans, visit one of our concierge centers listed on page 8, attend a community event,(1) or ask your
Freedom Health agent to stop by.
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This information is available for free in other languages. Please call our customer
service numberToll-Free at:
1-800-401-2740 TTY: 711
Hours:8 am to 8 pm,
7 days a week from October 1 to February 14
and 8 am to 8 pm,
Monday through Friday from February 15th to September 30th.
www.freedomhealth.com