Select Plan

Available to residents of Washoe County and Carson City.

$180/mo

With a maximum out-of-pocket of just $2,500 per year, the Select Plan is a great choice for individuals who frequently access health care. The Select Plan also offers great value on its prescription drug coverage.

Benefits Include:

Primary Care Visit	$0 / $10 per visit
Specialist Visit	$25 per visit
Routine Lab Services	$0 per visit
Urgently Needed Care	$20 / $45 per visit ($0 Teladoc)
Over-the-Counter Benefit	$75 Quarterly
Dental Coverage	$2,000 Comprehensive Included

Copayments listed are for preferred facilities.

How to enroll

All Northern Nevada Plans

Medical
Prescriptions
Documents

Doctors & Hospitals	Amount You Will Pay
Maximum Out-of-Pocket	$2,500 per year
Primary Care Office Visit	$0 / 10 per visit
Specialist Office Visits	$25 per visit
Urgently Needed Care	$20 / $45 per visit ($0 Teladoc)
Routine Lab Services	$0 per visit
Diagnostic Tests (X-ray, CT, MRI)	$45 / $65 / $90 per visit
Emergency Room Care	$120 per visit
Ambulance Services	$250 per trip
Inpatient Hospital	Preferred Facility: $250 / 4 day per period; Non-Preferred Facility: $440 / 5 days per period
Outpatient Hospital Services	Preferred Facility: $225 per visit; Non-Preferred Facility: $440 per visit

Prescription Coverage	Amount You Will Pay for Preferred Medications
Coverage in the Gap	$0 / $0 / $0 (Tiers 1, 2, 6)
Rx Deductible	No deductible
Preferred Generic (Tier 1)	$0 (30-day)
Non-Preferred Generic (Tier 2)	$0 (30-day)
Preferred Brand (Tier 3)	$41 (30-day)
Non-Preferred Brand (Tier 4)	$94 (30-day)
Specialty Drugs (Tier 5)	33% coinsurance
Select Drug (Tier 6)	$0 (30-day)
90-day Retail / 90-day Mail Order	2.5 times 30-day / 2 times 30-day

Evidence of Coverage Updated 09/30/21
Evidence of Coverage (Spanish) Updated 09/30/21
Summary of Benefits Updated 09/30/21
Annual Notice of Change Updated 09/30/21
Benefits at a Glance Updated 09/30/21
Benefits at a Glance (Spanish) Updated 09/30/21

Over-the-Counter (OTC) Benefit
Members on the Select Plan receive a $75 quarterly over-the-counter to use towards qualifying over-the-counter products like medications, health supplies and more.

View the OTC Catalog - Updated 01/01/22

Priority Access to Renown Health
Senior Care Plus members who select a Renown primary care provider get priority access to the Renown Health network and receive a Personal Assistant.

What is a Personal Assistant?

DispatchHealth
In Washoe County, members can call DispatchHealth to receive an in-home care for the same co-pay as a visit to Urgent Care.

Get care at home

Summary

The Select Plan has all of our extra benefits: preventive and comprehensive dental, over-the-counter (OTC) allowance, gym benefit, vision, and hearing with the lowest out-of-pocket maximum of any of our plans. The Select Plan also includes the new Senior Savings Program on select Insulins for the low copay of $35 for a 30 day supply. Your select insulins will be covered all year at this copayment and will not increase in price.

The Select Plan includes our entire network of doctors and specialists including priority access to Renown Health providers and facilities. Personal Assistants, who can help schedule appointments and navigate the healthcare system are included when you select a Renown Primary Care Provider (PCP).

Above is a partial list of benefits and should not be construed as a complete list. Please refer to the Evidence of Coverage in the plan documents section above for a complete list of benefits.

Out-Of-Network Providers: If you use an out-of-network provider, your share of the costs for your covered services may be higher. Out-of-network providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

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Senior Care Plus
A Medicare Advantage organization from Hometown Health

Material ID: H2960_2023_SCPWebsite1_M (CMS Accepted)

Last updated: March 3 2022