Medicare Plans

Plan Details

NetworkCares (PPO SNP)

Ideal for those who have both Medicare and Medicaid.

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Premium

0$ per month

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  • Same costs for in- and out-of-network providers
  • Prescription drug coverage
  • Vision benefits
  • Dental benefits
  • 100% coverage for preventive care
  • SilverSneakers® Fitness benefit
  • Hearing aid discount benefit

 

 

Services with a 1 may require prior authorization.
Premium
Deductible
Maximum Out-of-Pocket
Inpatient Hospital Coverage1
Outpatient Surgery Services1
Primary Care Provider
Specialist
Preventive Care
Emergency Room
Urgent Care
Low Cost Lab
Lab and Clinical Diagnostic Tests
Outpatient X-rays
Ultrasound, EKGs, EEGs, Stress Test
Radiation Therapy
Diagnostic Radiology Services (Such as MRIs, CT Scans)
Medicare Covered Hearing Exams
Medicare Covered Dental1
Supplemental Dental
Medicare Covered Eye Exam
Supplemental Vision
Inpatient Mental Health Care
Outpatient Mental Health Care
Skilled Nursing Facility1
Physical Therapy
Ambulance
Transportation
Medicare Part B Drugs and Chemotherapy
Medicare Part D Drugs
Chiropractic Care
Diabetes Monitoring Supplies and Test Strips1
Diabetes Self-Monitoring Training1
Therapeutic Shoes/Inserts1
Prosthetic Devices1
Related Medical Supplies1
Home Health Care1

 

When your coverage starts, you pay a deductible for tiers 3, 4 and 5 only; and copayments until total drug costs (what you and Network Health pay) reach $3,820.
Drug Deductible

30-Day Supply Preferred Pharmacy
or Mail Order Pharmacy
     
     

30-Day Supply Standard Pharmacy
     
     

90-Day Supply Preferred Pharmacy
     
     

90-Day Supply Standard Pharmacy
     
     

31 to 90-Day Mail Order Pharmacy

90-Day Mail Order Pharmacy
     
     

Coverage Gap
Catastrophic Coverage

This information is not a complete description of benefits. Call 800-378-5237 (TTY 800-947-3529) for more information. Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. 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.


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.