Benton Kansas, Missouri, Arkansas As a local health plan with national support, Coventry combines affordable plan options with easy access to a network that includes the doctors and hospitals your clients know and trust so they can get the care they need, when they need it. PRODUCTS HMO, PPO and HMO-POS plan options Missouri Kansas AVAILABILITY Riley Geary Shawnee Jefferson Leavenworth Douglas Platte Wyandotte Miami Clinton Clay Jackson Cass Lafayette Livingston Carroll Saline Arkansas Counties - Benton, Carroll, Crawford, Franklin, Garland, Logan, Madison, Montgomery, Pulaski, Scott, Sebastian, Washington and White Henry Benton Linn Bates Harvey St. Clair Hickory Bourbon Pulaski Butler Cedar Phelps Sedgwick Dallas Polk Laclede Barton Dade Greene Webster Wright Montgomery Labette Jasper Cherokee Lawrence Christian Newton Douglas Barry Stone Service Area Expansion McDonald Taney Ozark Existing Counties Carroll Madison Washington Crawford Arkansas Franklin Sebastian Logan White Scott Pulaski Garland Montgomery Kansas Counties - Bourbon, Butler, Cherokee, Douglas, Geary, Harvey, Jefferson,, Labette, Leavenworth, Linn, Miami, Montgomery, Riley, Sedgwick, Shawnee and Wyandotte Missouri Counties - Barry, Barton, Bates, Benton, Carroll, Cass, Cedar, Clay, Christian, Clinton, Dade, Dallas, Douglas, Greene, Henry, Hickory, Jackson, Jasper,, Laclede, Lafayette, Lawrence, Livingston, McDonald, Newton, Ozark, Platte, Phelps, Polk, Pulaski, St. Clair, Saline, Stone, Taney, Webster and Wright MEDICARE ELIGIBLES 581,528 Medicare Eligibles in the KS/MO/AR service area NETWORK HIGHLIGHTS/PRODUCT STRENGTHS & BENEFITS NEW for 2012! Maximum Out-of-Pocket reductions More $0 premium plans to choose from Copay reductions in most benefit categories HMO available in Arkansas High Performing Network available in Missouri Kansas City metro PPO plan: St Lukes hospitals, St Joseph Health Center, Centerpoint, The University of Kansas Medical Center and Shawnee Mission Medical Center. HMO plan: Research Hospital, The University of Kansas Medical Center and Centerpoint. Wichita area: Via Christi network and the Wesley hospital system. Low copays for prescription drugs Fitness benefi ts included $0 copay for preventive services $0 plan premium 4 and 4.5 Star-rated plans (HMO and PPO)
Kansas, Missouri, Arkansas Advantra Advantage (Kansas City) Advantra Freedom (Kansas City) Advantra Freedom (Wichita) Advantra Total Care (Wichita) Monthly Premium $0 $0 $0 $0 Deductible $0 $0 $0 $0 Maximum Out-of-Pocket $3,400 $3,950 $3,400 $2,900 $65 copay PCP/Specialist Visit $5/$30 copay $20/$40 copay $10/ $0/$30 copay Inpatient Hospital $200/1-7 $250/1-7 $200/1-7 $250/1-7 SNF $0/1-20, $100/21-100 X-ray/Diagnostic Radiology $0/ $150 CT scans, $250 MRI, MRA, PET scans $0/1-3, $50/4-20, $100/21-100 $0/ $150 CT scans, $400 MRI, MRA, PET Scans $0/1-3, $50/4-20, $100/21-100 $0/ $150 CT scan, $225 MRI, MRA, PET scan $0/1-20, $100/21-100 $0/ $150 CT scan, $200 MRI,MRA PET scans Preventive Services $0 copay $0 copay $0 copay $0 copay Dental Vision Hearing $0 Oral Exam, Cleaning, X-ray/1 per year; $500 limit per year preventive dental benefi ts $30 supplemental eye exam/1 per year; $100 limit for eyewear every year $5 supplemental hearing exam, hearing aid fi tting exam/1 per year; $500 limit supplemental routine hearing aids every 3 years $35 supplemental eye exam 1 per year; $100 limit for eyewear every year $0 Oral Exam, Cleaning, X-ray 1 per year; $500 limit per year preventive dental benefi ts $0 supplemental eye exam 1 per year $0 supplemental hearing exam, hearing aid fi tting evaluation 1 per year; $500 limit supplemental routine hearing aids every 3 years Fitness Program Yes Yes Yes Yes
Kansas, Missouri, Arkansas Advantra Premier Plus Advantra Total Care Mercy MedicareADVANTAGE (HMO - POS) Mercy MedicareADVANTAGE Monthly Premium $0 $0 $0 $13.30/$0 without Part D Annual Deductible $0 $0 $0 $0 Maximum Out-of-Pocket $4,800 In network $10,000 Out of network $7 copay $40 copay $2,900 $2,900 $3,100 $5 copay $7 copay $40 copay PCP Visit $15 copay $5 copay $5 copay $10 copay Specialist Visit $40 copay $40 copay $40 copay $30 copay Lab $0 copay $0 copay $0 copay $0 copay Emergency Room $65 copay $65 copay $65 copay $65 copay Inpatient Hospital $220 days 1-8 $175 days 1-7 $220 days 1-9 $150 days 1-5 Outpatient Surgery $350 $200 $350 copay $125 copay Preventive Services $0 copay $0 copay $0 copay $0 copay Fitness Program Silver&Fit Dental Preventive (2) exams, cleanings, X-ray every yr Up to 2 oral exams, cleanings, dental X-rays per year ($500 limit) Vision Routine eye exam plus $150 every 24 months for routine eyewear Routine eye exam plus $150 every 24 months for routine eyewear
Texas TEXAS: As a local health plan with national support, Coventry has substantial resources ready to serve your clients. Our flexible plan options provide easy access to the providers and hospitals your clients know and trust so they get the care that s right for them. PRODUCT PPO plan options AVAILABILITY El Paso Lubbock Midland DentonCollin Rockwall 4 Parker Tarrant Dallas Kaufman Bowie Bexar, Bowie, Brazoria, Collin, Dallas, Denton, El Paso, Fort Bend, Harris, Jefferson,, Kaufman, Lubbock, Medina, Midland, Montgomery, Nueces, Parker, Rockwall and Tarrant Montgomery Bexar Medina Harris Fort Bend Brazoria Jefferson MEDICARE ELIGIBLES 1,236,135 Medicare Eligibles in the Texas service area Nueces NETWORK HIGHLIGHTS/PRODUCT STRENGTHS & BENEFITS NEW for 2012! New High Performing Network (HPN) plan in Bexar County, affiliated with Methodist, that includes vision, dental and hearing value-adds Lower copays for many benefits Lower MOOPs Houston area: Christus Hospitals, Memorial Hermann Hospitals and the Select Specialty Hospitals. Dallas area: Dallas Regional Medical Center And the Kindred Hospitals. San Antonio region: HCA Methodist Hospital System and Medina Regional Hospital. Free health club membership $0 deductible Low PCP copays
Texas Set your SIGHTS ON SUCCESSS TEXAS: Advantra Advantra Total Care Monthly Premium $0 $0 Maximum Out-of-Pocket $3,400 $3,200 Inpatient Hospital $195/1-6 $175/1-5 SNF $0/1-3, $50/4-20, $100/21-100 copay $0/1-3, $50/4-20, $100/21-100 copay PCP Visit $10 copay $5 copay Specialist Visit $40 copay $40 copay Outpatient Surgery $200 copay $175 copay Emergency Room $65 copay $65 copay Lab $0 copay $0 copay X-ray $0 copay $0 copay Preventive Services $0 copay $0 copay Fitness Program Yes Yes Worldwide urgent/emergency Care Yes Yes Dental No Yes Hearing No Yes Vision Yes Yes