Summary of Benefits
You have options for your Medicare Advantage coverage. Think about your needs and what type of benefits will help you most. AmeriHealth Caritas VIP Care (HMO SNP) offers all the benefits of regular Medicare, plus more.
AmeriHealth Caritas VIP Care provides:
- Coverage for inpatient hospital care, as well as skilled nursing facility and home health care coverage.
- Preventive services to help you stay healthy.
- A large network of doctors, hospitals, specialists, and pharmacies.
- Great service and personal attention.
Plus, you'll get extra benefits, including:
- Dental, vision, and hearing benefits not covered by Original Medicare.
- Wellness education including smoking cessation and a nurse hotline.
- Transportation to your provider.
Below is a brief summary of key benefits.
You may also view:
- A pre-enrollment checklist (PDF).
- A complete Summary of Benefits (PDF).
- A complete Annual Notice of Changes — ANOC (PDF).
- The ANOC tells you about all plan changes in the next year.
- Spanish ANOC (PDF).
- A complete Evidence of Coverage (PDF).
- The EOC tells you how to get medical care and prescription drugs through our plan. The booklet explains what's covered, how much you'll pay for services, and all about your rights and responsibilities.
- You can also contact AmeriHealth Caritas VIP Care for more information.
Find a provider in our network for the benefits listed below.
|Premium||$0 monthly plan premium.|
|Doctor office visits||$0 copay for each Medicare-covered primary care provider (PCP) visit.|
$0 copay for each Medicare-covered specialist visit.
No referral required.
|Preventive and comprehensive dental||
$1,000 plan coverage limit for preventive dental benefits every year.
$0 copay for the following preventive dental benefits:
The combined total comprehensive dental benefits cannot exceed $3,000 every year. The comprehensive dental benefits include the following services up to a $3,000 combined limit every year:
*Prior authorization is required for dentures, periodontics, endodontics, crowns, mini implants, and implant supported dentures. Fixed bridges and all other dental implants, except for mini-implants, are not covered.
Diagnostic hearing and balance evaluations performed by your PCP to determine if you need medical treatment are covered as outpatient care when furnished by a physician, audiologist, or other qualified provider.
You must receive your care from a network provider. We will only pay for covered hearing services if you go to an in-network hearing provider. In most cases, you will have to pay for care that you receive from an out-of-network provider.
Covered services include:
Our plan offers supplemental vision coverage including:
The eyewear allowance only applies to the following limited eyewear benefits: Fashion / Designer / Premier frames collections; Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx); Tinting of Plastic Lenses; and Scratch-Resistant Coating. Or in lieu of eyeglasses, the $350 allowance may be applied to a limited selection of visually required contact lenses. Additional charges may apply for eyewear benefits that are not listed here.
You must receive your care from a network provider. We will only pay for covered vision services if you go to an in-network vision provider. In most cases, you will have to pay for care that you receive from an out-of-network provider.
$0 for up to 100 one-way trips to plan-approved locations every year. May consist of car, shuttle, or van service depending on appropriateness for situation.
Authorization and scheduling rules apply.
|Over-the-counter (OTC) items||
You may spend up to $365 per quarter for (OTC) items from our OTC catalog (PDF). Money not spent in a quarter does not roll over into the next quarter.
|Home health care||$0 copay for Medicare-covered home health visits.|
|Outpatient mental health care||
$0 copay for each Medicare-covered individual therapy visit.
$0 copay for each Medicare-covered group therapy visit.
$0 copay for each Medicare-covered individual therapy visit with a psychiatrist.
$0 copay for each Medicare-covered group therapy visit with a psychiatrist.