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MD Care Benefit Plans

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MD Care Benefits 2008	MD Care Health Plans
Benefits	Advantage I	Advantage II	Advantage Platinum	Advantage Gold
Summary of Benefits	Download	Download	Download	Download
Evidence of Coverage	Download	Download	Download	Download
Part B Premium Credit	$5 credit	$0	$7 credit	$26 credit
PCP/Specialist	$0 / $0	$0 / $0	$0 / $0	$5 / $10
Chiropractic	$0	$0	$0	$10
Podiatry	$0 / $0	$0 / $0	$0	$10
Generic/Mail Order	$0 / $0	$0 / $0	$0 / $0	$0 / $0
Preferred Brand/Mail Order	$15 / $30	$10 / $20	$10 / $20	$10 / $20
Non Preferred Brand/Mail Order	$50 / $100	$50 / $120	$20 / $50	$30
Specialty RX	25% Coinsurance	20% Coinsurance	25% Coinsurance	20% Coinsurance
Gap Coverage	Yes	Yes	Yes	Yes (Generic & Preferred Brand)
Hospital	$0	$0 Max Days - Unlimited	$50 Days 1 - 8 $0 Days 9 - 90 $400 Max out of Pocket Stay Max Days - Unlimited	$0/day 1 - 2 $50/day 3 - 9 $0/day 10 - 90 Max Days - Unlimited
Inpatient Mental	$150 deductible $0 up to 190 days Max Days 190 Lifetime	$50 Days 1 - 8 $0 Days 9 - 90 Max Days 190 Lifetime	$50 Days 1 - 8 $0 Days 9 - 90 Max Days 190 Lifetime	$50 Days 1 - 8 $0 Days 9 - 90 Max Days 190 Lifetime
SNF	$0 Days 1 - 20 $0 Days 21-100	$0 Days 1 - 20 $20 Days 21 - 100	$0 Days 1 - 20 $20 Days 21 - 100	$0 Days 1 - 20 $20 Days 21 - 100
Outpatient Ambulatory Surgical Center	$0	$0	$25	$0
Ambulance	$50	$50	$50	$50
ER Co-pay	$50	$50	$50	$50
World Wide Emergency Coverage	Yes	Yes	Yes	Not covered
Urgent Care	$0	0-$25	0 - $25	$25
DME	10% Coinsurance	0% - 15% Coinsurance	15% Coinsurance	20% Coinsurance
Prosthetics	0% Coinsurance	0% Coinsurance	0-15% Coinsurance	20% Coinsurance
Diagnostic lab	$0	$0	$0	$0
Therapeutic Radiology	0	0	0	$20
Diagnostic X-Rays	$0	$0	$0	$0
Dental Cleaning	Yes	Yes	Yes	Yes
Hearing Aids	$0 Up to $400/year	$0 up to $400/year	$0 up to $350/year	$0 up to $400 2/3 years
Eye Glasses	$0 Up to $200/2 years	$0 up to $250/year	$0 up to $200/year	$0 up to $200/2 years
Transportation	$0 (24 one way/year)	$0 (24 one way/year)	$0 (12 one way/year)	$0 (12 one way/year)