AHM_Standard (HMO) 2012
The AHM_Standard (HMO) plan is designed for Medicare beneficiaries who require a high frequency use of monthly prescription medicines, since the co-payments are lower.
$0 monthly premium
$0 deductible$0 copayment on PCP visits
$5 copayment on visits to participating specialists
$0 copayment on laboratories and X-rays
$0 copayment on Shower Chairs
Erectile Dysfunction Medicines*
$0 copayment on Blood Pressure Monitors
$50 every six months for over-the-counter drugs (OTC)
$3-$6 copayment on generic prescription drugs
$30-$45 copayment on brand prescription drugs
* 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_Standard (HMO) H5774_1027_12_01_E File & Use 08302011
Evidence of Coverage AHM_Standard (HMO) H5774_1027_12_01_E File & Use 08302011
Errata Sheet to AHM_Standard (HMO) ANOC/EOC H5774_1030_12_01_E CMS Approved 09072011
Summary of Benefits AHM_Standard (HMO) H5774_1001_12_02_E CMS Approved 09292011
Last Updated 10/06/2011
