AHM_Classic (HMO) 2012
The AHM_Classic (HMO) plan is designed for Medicare beneficiaries who need additional benefits such as adult diapers and/or nutritional oral supplements. Furthermore, it is promoted in elderly homes for patients who are not beneficiaries of “Mi Salud”.
$0 monthly premium
$0 deductible
$0 copayment on PCP Visits
$10 copayment on visits to participating specialists
$0 copayment on laboratories and X-rays
$0 copayment on Oral Nutritional Supplements *
$0 copayment on Blood Pressure Monitors *
$0 copayment on Adult Diapers (incontinence) *
$0 copayment on Shower Chairs *
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Annual Notice of Change AHM_Classic (HMO) H5774_1027_12_02_E File & Use 09052011
Evidence of Coverage AHM_Classic (HMO) H5774_1027_11_02_E File & Use 09052011
Errata Sheet to AHM_Classic (HMO) ANOC/EOC H5774_1030_12_02_E CMS Approved 09072011
Summary of Benefits AHM_Classic (HMO) H5774_1001_12_03_E CMS Approved 09292011
Last Updated 10/06/2011
