AHM_Opal (HMO POS) 2011
The AHM_Opal (HMO POS) plan is designed for Medicare beneficiaries who want to receive the benefits of a Medicare Advantage Plan and still have the flexibility of being able to visit non-participating providers.
$0 monthly premium
$0 deductible
$0 copayment on PCP visits and visits to participating specialists
$0 copayment on laboratory and X-rays Up to
$750 annually on Comprehensive Dental Services
Erectile Dysfunction Medicines*
$0 copayment on Blood Pressure Monitors*
$0 copayment on Shower Chairs
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Some of the “out-of-network” services covered:
40% of costs from visits to primary physicians
20% of costs from visits to participating specialists
20% of costs from other services not covered in the network
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Opal (HMO POS) H5774_1027_11_04_E File & Use 101022010
Summary of Benefits AHM_Opal (HMO POS) H5774_1001_11_06_Er1 CMS Approved 10182011
Last Updated 10/06/2011
