BeWell (HMO SNP) Medicare ( ) (HMO) (Bronx) (Brooklyn) (Nassau) (New York) (Queens) (Suffolk) (Westchester) (National Committee fo

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1 BeWell (HMO SNP) Medicare ( ) (HMO) H4922_002_AWNY1065C_16 File & Use

2 BeWell (HMO SNP) Medicare ( ) (HMO) (Bronx) (Brooklyn) (Nassau) (New York) (Queens) (Suffolk) (Westchester) (National Committee for Quality Assurance) (Special Needs Plan) H4922_002_AWNY1065C_16 File & Use

3 2016 BeWell (HMO SNP) / / _ (TTY)

4 2016 BeWell (HMO SNP) Medicare Medicaid 4

5 2016 BeWell (HMO SNP) 1 Medicare Original Medicare Original Medicare Medicare BeWell (HMO SNP) Medicare : BeWell (HMO SNP) Medicare Medicare Plan Finder Medicare Original Medicare Medicare & You Medicare MEDICARE ( ) 7 24 (TTY) BeWell (HMO SNP) (866) TTY : (800) BeWell (HMO SNP) BeWell (HMO SNP) (866) (TTY) (800) (866) (TTY) (800) BeWell (HMO SNP) Medicare A Medicare B Medicaid (Bronx) (Brooklyn)(Nassau) (New York) (Queens) (Suffolk) (Westchester) 5

6 2016 BeWell (HMO SNP) BeWell (HMO SNP) D ( Medicare Original Medicare Original Medicare Original Medicare Original Medicare D B D 6

7 2016 BeWell (HMO SNP) 2 $0 $39.70 Medicare B Medicaid $0 $ D $0 $74 Medicare Medicaid $3,400 D 7

8 BeWell (HMO SNP) Acupuncture 24 $10 Ambulance 1 Chiropractic Care Dental Services 20% 1 20% ( Diabetes Supplies and Services 1 20% 20% 20% Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may be different if received in an outpatient surgery setting) X 1 : (MRI) (CT scan) 20% 20% 20% X 20% 20% Doctor's Office Visits 20% 20% Durable Medical Equipment (wheelchairs, oxygen, etc.) 20% 1 Emergency Care 20% $75) 24 Foot Care (podiatry services) 1 / 20% 8

9 2016 BeWell (HMO SNP) Hearing Services 1 Home Health Care 1 Mental Health Care 1 Outpatient Rehabilitation 1 20% $ (SNF) SNF 60 SNF $ $1, $ $ % 20% % 20% 20% Outpatient Substance Abuse 1 20% 20% Outpatient Surgery 1 20% 20% Over-the-Counter Items 9

10 2016 BeWell (HMO SNP) Prosthetic Devices (braces, artificial limbs, etc.) 20% 1 20% Renal Dialysis 1 20% Transportation 1 Urgently Needed Services 20% ( $65) Vision Services $100 10

11 2016 BeWell (HMO SNP) X HIV (PSA) B Welcome to Medicare Medicare Medicare Medicare 11

12 2016 BeWell (HMO SNP) Inpatient Hospital Care 1 Inpatient Mental Health Care 1 Skilled Nursing Facility (SNF) 1 (SNF) SNF 60 SNF $ $1, $ $ $ $

13 2016 BeWell (HMO SNP) B 20% B 20% $0 $1.20 $2.95 $0 $3.60 $7.40 $4,850 13

14 2016 BeWell (HMO SNP) 3 BeWell (HMO SNP) (Over the Counter OTC) (OTC) $55 OTC OTC Medicare B D OTC OTC : (866) TTY (800) Medicaid Medicaid (Medicaid Benefit ID) Medicaid Silver Sneakers SilverSneakers SilverSneakers SilverSneakers (866) (800)

15 2016 BeWell (HMO SNP) 4 Medicare Medicaid Medicare Medicaid BeWell (HMO SNP) Medicare Medicaid Medicare Medicaid Original Medicare 2 3 Medicaid Medicaid Medicare Medicaid (Medicaid Fee for Service, FFS) Medicaid Medicaid New York State Department of Health (NYSDOH) (Coordination of Benefits) BeWell Medicare Medicaid Medicaid QDWI Medicare A QI Medicare B Medicare SLMB Medicare B Medicare QMB Medicare A / B D Medicaid Medicaid Medicaid Medicaid Medicaid (New York City Human Resources Administration) BeWell (HMO SNP) Medicaid Medicare Advantage Plan Medicaid Medicaid Medicaid Medicaid Medicaid ( )

16 2016 BeWell (HMO SNP) Inpatient Hospital Care including Substance Abuse and Rehabilitation Skilled Nursing Facility (SNF) Doctor Office Visits Podiatry Services Chiropractic Services Outpatient Substance Abuse Care Outpatient Mental Health Outpatient Services/Surgery / Ambulance Services Emergency Care Urgently Needed Care Outpatient Rehabilitation Services Prosthetic Devices Medicaid OMB OMB-Plus OMB OMB-Plus (20) 21 (Office for People with Developmental Disabilities) Medicaid 21 16

17 2016 BeWell (HMO SNP) Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies Diagnostic Tests, X-Rays, Lab Services, and Radiology Services X Bone Mass Measurement Colorectal Screening Exams Immunizations Mammograms X Pap Smears and Pelvic Exams Prostate Cancer Screening Exams End Stage Renal Disease Prescription Drugs Over the Counter Drugs Dental Medicaid Medicaid D Medicaid Medicare D Medicare Medicaid BeWell Plan (HMO SNP) Healthplex X / 17

18 2016 BeWell (HMO SNP) Transportation (Routine) Inpatient Mental Health Services (over 190-day lifetime limit) 190 Non-Medicare Covered Home Health Services Medicare Non-Medicare Covered Durable Medical Equipment Medicare Medical Equipment Private Duty Nursing Services Medicaid BeWell Medicare Medicaid / Medicaid Medicare DME 18

19 2016 BeWell (HMO SNP) Non-Medicare Covered Hearing Services Medicare Non-Medicare Covered Vision Services Medicare Hospice Physical Exams Health/Wellness Education / Out-of-Network Family Planning services provided under the direct access provisions of the waiver Personal Care Services Medicaid BeWell Plan (HMO SNP) Medicare Medicaid $500 / (2) (2) BeWell Plan (HMO SNP) Medicare Medicaid (1) (1) $100 Medicaid Medicaid 19

20 2016 BeWell (HMO SNP) Certain Mental Health Services Methadone Maintenance Treatment Programs (MMTP) Rehabilitation Services Provided to Residents of OMH Licensed Community Residence (CRs) and Family Based Treatment Programs OMH Office for People with Developmental Disabilities (OPWDD) Services Comprehensive Medicaid Case Management Medicaid Directly Observed Therapy for Tuberculosis (TB) Disease AIDS Adult Day Health Care AIDS HIV COBRA Case Management HIV COBRA Assisted Living Program Adult Day Health Care Personal Emergency Response Services (PERS) Medicaid Medicaid (Assertive Community Treatment ACT) (Personalized Recovery Oriented Services PROS) Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid 20

21 2016 BeWell (HMO SNP) English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at , or TTY Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al Alguien que hable español le podrá ayudar. Este es un servicio gratuito. Chinese Simplified: 我们提供免费的翻译服务, 帮助您解答关于健康或药物保险的任何疑问如果您需要此翻译服务, 请致电 , 或听障人士专线我们的中文工作人员很乐意帮助您这是一项免费服务 Chinese Traditional: 您對我們的健康或藥物保險可能存有疑問, 為此我們提供免費的翻譯服務如需翻譯服務, 請致電 , 或聽障人士專線我們講中文的人員將樂意為您提供幫助這是一項免費服務 Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurance-médicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Korean: 당사는의료보험또는약품보험에관한질문에답해드리고자무료통역서비스를제공하고있습니다. 통역서비스를이용하려면전화 번으로문의해주십시오. 한국어를하는담당자가도와드릴것입니다. 이서비스는무료로운영됩니다. Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: إننا نقدم خدمات المترجم الفوري المجانية لإلجابة عن أي أسئلة تتعلق بالصحة أو جدول األدوية لدينا. للحصول على مترجم فوري ليس.عليك سوى االتصال بنا على سيقوم شخص ما يتحدث العربية بمساعدتك. هذه خدمة مجانية 21

22 2016 BeWell (HMO SNP) Hindi 1 : हम र स स थ य य दव क य जन क ब र म आपक क स भ प रश न क जव ब द न क ल ए हम र प स म फ त द भ ष य स व ए उपलब ध ह. एक द भ ष य प र प त करन क ल ए, बस हम पर फ न कर. क ई व यल त ज ह नद ब त ह आपक मदद कर सक त ह. यह एक म फ त स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito. French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer Ta usługa jest bezpłatna. Japanese: 当社の健康健康保険と薬品処方薬プランに関するご質問にお答えするために無料の通訳サービスがありますございます通訳をご用命になるにはにお電話ください日本語を話す人者が支援いたしますこれは無料のサービスです 1 MMG MMG word 22

23 2016 BeWell (HMO SNP) 23

24 (TTY/TDD) agewellnewyork.com Medicare HMO 1 1 Medicaid Medicare B (TTY)

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Jeff Davis Brand New Day Brand New Day Brand New Day Universal Care, Inc Medicare Brand New Day 1985 Brand New Day Brand New Day Brand New Day Brand N brand new day H E A LT H C A R E Y O U C A N F E E L G O O D A B O U T 2017 年註冊手冊 Healthy Heart Drug Savings (HMO SNP) Healthy Heart Dual Access (HMO SNP) 充血性心力衰竭或其他心力衰竭患者的特殊安排本手冊中有兩種健康保險福利找出對您收益最大的那一個