|
Institutional Plans |
Institutional Community Plans |
Dual-eligible Plan |
Fidelis
Secure
Comfort |
Fidelis
Secure Comfort
Plus |
Fidelis
Secure
Independence |
Fidelis
Secure
Freedom |
Fidelis
Secure
Liberty |
Monthly
Premium
Covers your
medical and
Part D Rx Drug
coverage.
|
$34.20
(in addition to your
Part B premium) |
$98
(in addition to your
Part B premium)
|
$149
(in addition to your Part B premium) |
$16.60
(in addition to your Part B premium) |
Your costs may
be as low as $0,
depending on your
level of Medicaid
eligibility. |
Inpatient
Hospital Care |
Medicare cost shares apply |
Days 1-10/$75 day
Days 11+/$0 day |
Days 1-10/$65 day
Days 11+/$0 day |
Medicare cost shares apply |
Medicare/ Medicaid cost shares apply |
Skilled Nursing Facility
100 day benefit period prior
hospital stay NOT REQUIRED |
$0 |
$0 |
$0 |
Medicare cost shares apply |
Medicare/ Medicaid cost shares apply |
Comprehensive Part D
Prescription Drug Coverage
For Rx Drug
Benefit details,
click here |
$325 deductible
25% coinsurance |
$0 deductible
Tier 1: $ 5
Tier 2: $30
Tier 3: $65
Tier 4: 33% |
$0 deductible
Tier 1: $ 5
Tier 2: $30
Tier 3: $65
Tier 4: 33% |
$325 deductible
25% coinsurance |
$0 deductible
Tier 1:
$0/$1.15/$2.65
All other drugs: $0/$3.50/$6.60 |
| Primary Care Physician Visits |
$0 |
$0 |
$0 |
$0 |
$0 |
Specialist/ Podiatry/
Chiropractic
Visits |
20% coinsurance |
$0 |
$0 |
20% coinsurance |
$0 - 20%
coinsurance |
Dental/Vision/
Hearing
Supplemental Basket Benefits |
$0 copay
$500 annual
benefit |
$0 copay
$500 annual
benefit |
$0 copay
$400 annual
benefit, plus
Dental = $400
Eyewear = $150
Hearing aids = $250 |
$0 copay
$400 annual
dental benefit, plus
$400 vision,
hearing & supplemental benefits |
$0 copay
$400 annual
dental benefit, plus
$325 vision,
hearing & supplemental
benefits |
Transportation
(12 trips to approved
locations) |
$0 |
$0 |
$0 |
$0 |
$0 |
Preventive Wellness & Education
Services |
$0 copay for all Medicare-covered Preventive, Wellness & Education Services |
Fidelis Secure Plans - 2013
Click on the plan of your choice to review the Summary of Benefits.
For a Fidelis Secure Plan Enrollment Form, click here.
We welcome the opportunity to discuss all the benefits of Fidelis SecureCare to help you find the plan that’s right for you.
Contact us today.
For additional information about Medicare coverage and other Medicare-related questions, visit the official Medicare website www.Medicare.gov.
Disclaimer Information
Fidelis SecureCare is a Medicare Advantage organization with a Medicare contract. To join our plan you must have Medicare Part A and Part B, and reside within the service area. You may enroll in the plan or make changes to coverage you already have only during specific times of the year and must continue to pay your Medicare Part B premium. The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. Additional information about benefits is available to assist you in making a decision about your coverage. Documents may be available in a different format or language. Certain restrictions and limitations may apply. Benefits, Formulary, pharmacy network, premium and/or co-payments/coinsurance may change January 1, 2014. This is an Advertisement.
Our plan is required to notify beneficiaries that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice. For more information, please refer to the Evidence of Coverage or contact our Customer Service Department at: 877-372-8085, Mon – Fri. between 8:00am – 8:00pm. TTY/TTD users, call: 888-844-5530.
As a member of Fidelis SecureCare, you have rights and responsibilities upon disenrollment. You may end your membership in our plan only during certain times of the year, known as enrollment periods. However, there are certain situations, in which you may be eligible to end your membership at other times of the year. This is known as a Special Enrollment Period. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the Medicare Advantage Disenrollment Period.
For more information on disenrollment, please refer to your Evidence of
Coverage, Chapter 10 "Ending your membership in the plan" or call our
Customer Service Department at 877-372-8085, Mon. – Fri. between 8:00am – 8:00pm, TTY/TTD users should call: 888-844-5530.