<a style='color:rgb(255,255,255);font-size: 1em;'>2019 Freedom Plans</a>
Doctors & Hospitals Amount You Will Pay
PCP Office Visits $20 per visit
Specialist Office Visits $50 per visit
Inpatient Hospital $350 / 5 days per period
Emergency Room Care $120 per visit
Diagnostic and X-Ray $100 / $140 / $180 per visit
Routine Lab Services $0 per visit
Outpatient Hospital Services $350 per visit
Prescription Coverage Amount You Will Pay
Coverage in the Gap Not Covered
Preferred Generic-Tier 1 $8 (30-day supply)
Non-Preferred Generic-Tier 2 $16 (30-day supply)
Preferred Brand-Tier 3 $47 (30-day supply)
Non-Preferred Brand-Tier 4 $100 (30-day supply)
Specialty Drugs-Tier 5 28% coinsurance
Select Care Drugs-Tier 6 $4 (30-day supply)

Plan highlights

  • Enhanced Preventive Care
    Includes a free annual wellness visit and a wide variety of vaccinations and preventative screenings (including cardiovascular and cancer) at no charge.

  • Hearing & Vision
    Includes $45 annual hearing exam and two hearing aids per year; $699 / $999. Also includes routine vision coverage of $25 per exam - $150 allowance.

  • Gym Membership
    Includes a year-long gym membership at one of the participating fitness facilities.

Material ID: Y0039_2019_SCPWebsite_M (CMS Accepted) Last Updated 11/09/2018