PLAN HIGHLIGHTS

THE ESSENTIAL PLAN

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Questions? Call us at 775-982-3158

See The Provider Directory Here

View Dental summary of benefits here

See The Formulary & Pharmacy benefits here

$0 Premium & $0 Preferred PCP visits
$25 Quarterly Over-the-Counter (OTC) Benefit
$0 Hearing Exams & Vision Exams
$0 Teladoc and low-cost DispatchHealth home visits
Preventive Dental Coverage
Fitness Benefit with select gyms

Essential Plan

Available to residents of Washoe County and Carson City.

$0/mo

The Essential Plan offers residents of Washoe County and Carson City access to our widest provider network, with a $0 monthly premium. Essential Plan members are can select a community provider as their Primary Care Provider while still enjoying priority access to Renown Health providers and facilities.

Benefits Include:

Primary Care Visit	$0 per visit (preferred PCP) $10 per visit (non preferred PCP)
Specialist Visit	$50 per visit
Routine Lab Services	$0 per visit
Urgently Needed Care	$35 / $65 per visit ($0 Teladoc)
Over-the-Counter Benefit	$25 Quarterly
Dental Coverage	Preventative Included

Co-payments listed are for preferred facilities.

How to enroll

All Northern Nevada Plans

Medical
Prescriptions
Documents

Doctors & Hospitals	Amount You Will Pay at Preferred Facilities
Maximum Out-of-Pocket	$3,300 per year
Primary Care Office Visit	$0 per visit (preferred PCP) $10 per visit (non preferred PCP)
Specialist Office Visits	$50 per visit
Urgently Needed Care	$35 / $65 per visit ($0 Teladoc)
Routine Lab Services	$0 per visit
Diagnostic Tests (X-ray, CT, MRI)	$70 / $100 / $135 per visit
Emergency Room Care	$125 per visit
Ambulance Services	$325 per trip
Inpatient Hospital	Preferred: $300 / 5 days per period Non-Preferred: $440 / 5 days per period
Outpatient Hospital Services	Preferred: $300 per visit Non-Preferred: $440 per visit

Prescription Coverage	Amount You Will Pay for Preferred Medications
Coverage in the Gap	Preferred $2.50 (Tier 6) Non-preferred $8.50 (Tier 6)
Rx Deductible	No deductible
Preferred Generic (Tier 1)	Preferred $5 Non-Preferred $11
Non-Preferred Generic (Tier 2)	Preferred $12 Non-preferred $20
Preferred Brand (Tier 3)	Preferred $41 Non-preferred $47 Senior Savings $35
Non-Preferred Brand (Tier 4)	Preferred $94 Non-preferred $100
Specialty Drugs (Tier 5)	33% coinsurance
Select Drug (Tier 6)	Preferred $2.50 Non-preferred $8.50
90-day Retail / 90-day Mail Order	2.5 times 30-day / 2 times 30 day

Evidence of Coverage Updated 03/22/23
Evidence of Coverage (Spanish) Updated 03/24/23
Summary of Benefits Updated 09/30/22
Annual Notice of Change Updated 09/30/22
2023 Benefits Brochure Updated 09/30/22
Liberty Dental Provider Directory Updated 09/30/22
Over-the-Counter Catalog Updated 09/30/22

Healthy Me 2023 Benefits Brochure

See all the new 2023 benefits in the Healthy Me 2023 Benefits Brochure – includes OTC Catalog and Dental Directory

2023 Benefits Brochure

Priority Access to Renown Health

Essential Plan members can choose to see any community provider including priority access to Renown Health providers and facilities.

Provider Directories

Virtual Visits

Senior Care Plus members have two options when accessing virtual care: Renown Health virtual visits (for urgent, primary and specialty care) and Teladoc (for urgent care and dermatology).

Virtual Visit Options

Summary

The Essential Plan is the right option for you if your primary care physician is not a Renown provider. The Essential Plan includes the entire Senior Care Plus network of doctors and specialists, including priority access to Renown Health facilities.

The Essential Plan has been enhanced in 2023 with an updated hearing benefit from NationsHearing® that includes a $0 hearing exam and a generous hearing aid benefit. NationsOTC® provides a $25 quarterly Over-the-Counter benefit with free two-day shipping. The plan also has a Preventive Dental benefit from Liberty Dental.

The prescription drug coverage included in the Essential Plan is extensive, and includes select insulins at the $35 Senior Savings Program cost.

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 24 2023