<a style='color:rgb(255,255,255);font-size:1.1em;'>2019 Value Plans</a>
Doctors & Hospitals Amount You Will Pay
PCP Office Visits $20 per visit
Specialist Office Visits $50 per visit
Inpatient Hospital $300 / 6 days per period
Emergency Room Care $90 per visit
Diagnostic and X-Ray $70 / $105 / $140 per visit
Routine Lab Services $0 per visit
Outpatient Hospital Services $300 per visit
Prescription Coverage Amount You Will Pay
Coverage in the Gap Not Covered
Preferred Generic-Tier 1 Not Covered
Non-Preferred Generic-Tier 2 Not Covered
Preferred Brand-Tier 3 Not Covered
Non-Preferred Brand-Tier 4 Not Covered
Specialty Drugs-Tier 5 Not Covered
90-Day Supply Not Covered

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.

  • $20 PCP Visit
    Includes $20 Primary Care Provider Office visit copay.

  • Durable Medical Equipment
    The plan pays 80% of the cost of in-network purchases of durable medical equipment like wheelchairs. If you choose a preferred vendor, your cost may be less.

Material ID: Y0039_2019_SCPWebsite_M (CMS Accepted) Last Updated 11/21/2018