Charter+Rx and Charter
The following are the changes for Charter+Rx and Charter plans.
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Our Charter+Rx plan has had the following benefit changes effective January 1, 2011:
| Benefit | 2010 | 2011 |
|---|---|---|
| Chiropractic Services | $25 Copay | $15 Copay |
| Diagnostic Tests | $0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, CT, PET scans & nuclear medicine; $0 Copay for therapeutic radiology services |
$0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, MRA, CT, CTA, PET, SPECT scans; $30 Copay for therapeutic radiology services |
| ESRD | 20% Coinsurance, $10 Copay for nutrition therapy for ESRD | 20% Coinsurance, $0 Copay for nutrition therapy for ESRD |
| Routine Vision | $30 Copay for one routine eye exam per year; $100 limit for vision hardware every 24 months | $0 Copay for one routine eye exam every 12 months from a VSP provider; $120 allowance toward the purchase of vision hardware from a VSP provider every 12 months with a $15 Copay |
Our Charter plan, which is now called Alpine, has had the following changes effective January 1, 2011:
| Benefit | 2010 | 2011 |
|---|---|---|
| Chiropractic Services | $25 Copay | $15 Copay |
| Diagnostic Tests | $0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, CT, PET scans & nuclear medicine; $0 Copay for therapeutic radiology services |
$0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, MRA, CT, CTA, PET, SPECT scans; $30 Copay for therapeutic radiology services |
| ESRD | 20% Coinsurance, $10 Copay for nutrition therapy for ESRD | 20% Coinsurance, $0 Copay for nutrition therapy for ESRD |
| Routine Vision | $30 Copay for one routine eye exam per year; $100 limit for vision hardware every 24 months | $0 Copay for one routine eye exam every 12 months from a VSP provider; $120 allowance toward the purchase of vision hardware from a VSP provider every 12 months with a $15 Copay |
H9302_Soundpath Health 2012 Website CMS Approved 10282011
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Important Disclaimers
Soundpath Health is a health plan with a Medicare contract. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Soundpath Health. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2012. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply. Individuals must have both Part A and Part B to enroll. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. Members may enroll in the plan only during specific times of the year. Contact Soundpath Health for more information. Medicare beneficiaries may enroll in Soundpath Health through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. *Members are 30 seconds or less away from speaking to a customer service representative based on 2010 annual internal telephone statistics.