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2013 MA Plan Summaries San Diego HMOs

HMO Premium : $0 MOOP: $3,400 PCP: $10 Specialist: $25 Hospital: $150 per days 1-8 PDP Benefit: $0/$10/$45/$95/33% Transportation Benefit, 24 Trips! $0 Generics in the Coverage Gap!. HMO-POS Premium: $39 MOOP: $5,000 (in)/$5,000 (out)

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2013 MA Plan Summaries San Diego HMOs

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  1. HMO • Premium: $0 • MOOP: $3,400 • PCP: $10 Specialist: $25 • Hospital: $150 per days 1-8 • PDP Benefit: $0/$10/$45/$95/33% • Transportation Benefit, 24 Trips! • $0 Generics in the Coverage Gap! • HMO-POS • Premium: $39 • MOOP: $5,000 (in)/$5,000 (out) • PCP: $10 (in)/$35 (out)Specialist: $25 (in)/$50(out) • Hospital: $150 per day 1-8(in)/$300per day 1-8(out) • PDP Benefit: $0/$10/$45/$95/33% • $0 Generics in the Coverage Gap! 2013 MA Plan Summaries San Diego HMOs • HMO-MA only • Premium: $0 • MOOP: $1,000 • PCP: $0 Specialist: $0 • Hospital: $0 per days 1-100 • PDP Benefit: not included • Dental • Vision • Fitness Membership

  2. San Diego Network, highlights and additions... • Scripps Mercy • Greater Tri Cities IPA • Vantage IPA • PCAMG IPA

  3. HMO-MA only • Premium: $0 • MOOP: $1,000 • PCP: $0 Specialist: $0 • Hospital: $0 per days 1-100 • PDP Benefit: not included • HMO-POS • Premium: $ 29 • MOOP: $3,400 • PCP: $0(in)/$35(out) Specialist: $5(in)/$50(out) • Hospital: $100 per days • 1-5)/$300per day 1-8(out) • PDP: $0/$10/$45/$95/33% • $0 Generics in the Coverage Gap! • HMO • Premium: $0 • MOOP: $3,400 • PCP: $0 Specialist: $5 • Hospital: $100 per days 1-5 • PDP Benefit: $0/$10/$41/$92/33% • Transportation Benefit, 24 Trips! • $0 Generics in the Coverage Gap! • HMO-SNP • Premium: $ 0 • MOOP: $2,400 • PCP: $0 Specialist: $0 • Hospital: $0 per days 1-100 • PDP: 25%/25%/25%/25%/25% 2013 MA Plan Summaries Riverside/San Bernardino HMOs

  4. San Bernardino Riverside Network, highlights and additions... • Prime Care • Choice IPA • Empire IPA • Vantage IPA • Anchor IPA • Emmit IPA • Riverside Physicians • Riverside Clinic

  5. PFFS – MA only • Premium: $49 • MOOP: $6,700 • PCP: $10 Specialist: $40 • Hospital: $220 per days 1-8 • PDP Benefit: Not included • PFFS • Premium: $82 • MOOP: $6,700 • PCP: $10 Specialist: $40 • Hospital: $220 per days 1-8 • PDP: $4/$8/$35/$70/25% 2013 MA Plan Summaries PFFS Expansion

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