PLAN HIGHLIGHTS

THE ENCOMPASS PLAN

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  • Prescription Drug Coverage

  • Routine Vision Coverage

  • Hearing Coverage

  • Fitness Benefit

  • Comprehensive Dental

Encompass Plan

Available to residents in Clark County with chronic health conditions.

$0/mo

If you have COPD, diabetes or congestive heart failure (CHF), you will want to select the Encompass Plan to get specialized benefits that support your chronic conditions.

Benefits Include:

Primary Care Visit $0 at CareMore / $5 in-network
Specialist Visit $0 at CareMore / $5 in-network
Routine Lab Services $0 per visit
Urgently Needed Care $0 at CareMore Anytime / $20 per visit out-of-network ($5 Teladoc)
Over-the-Counter Benefit $50 Quarterly
Dental COVERAGE $2,000 Comprehensive Included

Copayments above are for preferred facilities.

How to enroll
All Southern Nevada Plans
Doctors & Hospitals Amount You Will Pay
Maximum Out-of-Pocket $1,250 per year
Primary Care Office Visit $0 at CareMore / $5 in-network
Specialist Office Visits $0 at CareMore / $5 in-network
Urgently Needed Care $0 CareMore Anytime / $0 per visit elsewhere
Routine Lab Services $0 per visit
Diagnostic Tests (X-ray, CT, MRI) $0 / $40 / $100 per visit
Emergency Room Care $120 per visit
Ambulance Services $150 ground / air
Inpatient Hospital $0 per day (3 days), $50 per day (days 4-7), $0 per day (days 8-91), 180 day max
Outpatient Hospital Services $0 per visit
Prescription Coverage Amount You Will Pay
Rx Annual Deductible No Deductible.
Coverage in the Gap $0 / $5 / $0 (Tiers 1, 2, 6)
Preferred Generic (Tier 1) $0 (30-day)
Non-Preferred Generic (Tier 2) $5 (30-day)
Preferred Brand (Tier 3) $37 (30-day); Senior Savings: $35
Non-Preferred Brand (Tier 4) $85 (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

24/7 Access to CareMore Anytime
CareMore Health provides an extra layer of care on top of the services members receive from their personal doctor.

CareMore health

Comprehensive Dental Benefits
Members can utilize up to $2,000 of comprehensive dental benefits through in-network dental providers.

Find a Dentist

Over-the-Counter (OTC) Benefit
Senior Care Plus offers members on the Encompass Plan a $50 quarterly over-the-counter benefit.

View the OTC Catalog - Updated 01/01/22

Summary

If you have COPD, Diabetes or Congestive Heart Failure (CHF), you will want to select the Encompass Plan to get the specialized benefits that support your chronic condition. We are pleased to partner with CareMore Health to provide an extra layer of care on top of the services you receive from your personal doctor. Plus CareMore offers many health programs and services created to help keep you healthy and manage your chronic conditions.
The Encompass Plan offers $0 Primary Care and Specialists visits, with a maximum out-of-pocket maximum of just $1,250 per year.  Encompass plan members also have vision coverage, hearing coverage and a $2,000 dental benefit. The Gym Benefit is provided by Silver & Fit and members on the Encompass plan enjoy a $50 per quarter Over-the-Counter (OTC) benefit.  Along with worldwide emergency coverage, Comprehensive Plan members also have 24/7/365 access to Teladoc, which offers $0 virtual visits by phone or video nationwide.

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_2022_SCPWebsite1_M (CMS Accepted)

Last updated:  June 29 2022