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Prestige Plan (Downstate)

NOTE TO TOUCHSTONE HEALTH PLAN APPLICANTS:

Members may enroll in the plan only during specific times of the year. Contact Touchstone Health for more information.
Individuals must have both Part A and Part B to enroll. Click here to download an Enrollment Form. Upon submission of your online application, please complete the Coordination of Benefit forms and send to: Touchstone Health, Attn: Enrollment, 365 Harry L. Drive, Suite 120, Johnson City, NY 13790

2014 Touchstone Health Medicare Prestige Plan  SNP / Medicaid Advantage / Special Needs Plan (HMO-SNP)
Monthly Premium:
Geographic Coverage:   Bronx, Kings, Queens, Richmond, Westchester Counties
Monthly Premium:
PCP Copay: $0 copay1
Specialist Copay: $0 copay1
Includes: Over the Counter Benefits

More Info  More Information
In-Network Out-of-Pocket Maximum: $3400 In-Network
Inpatient Hospital Care2: $0 yearly deductible1; $0 copay1
Coverage in Coverage Gap: Generics1 - $0 copay; or $1.20 copay; or $2.55 copay
Brand1 - $0 copay; or $3.60 copay; or $6.35 copay
Tier 1 (Generic) Copay5: $0 copay; or $1.20 copay; or $2.55 copay1
Tier 2 (Preferred Brand) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
Tier 3 (Non-Preferred Brand) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
Tier 4 (Specialty Tier Drugs) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
 
Other Benefits
Preventive Dental Services: $0 copay1
Routine Hearing Exam4: $0 copay1
Routine Eye Exam4: $0 copay for routine1
Over the Counter Benefit: get $77 per month
Transportation: covered under medicaid services
Fitness: yes
Complementary Alternative Medicine: yes
Brain Games: yes
Other Benefits:
1 Based on your level of Medicaid eligibility.
2 Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
3 $0 copay for additional hospital days.
4 Up to 1 routine exam / yr.
5 Based on supply for one month (30-day) retail pharmacy.
6 Members should review their Summary of Benefits for details on coverage depending on Medicaid eligibility.
 
2014 Touchstone Health Medicare Prestige Plan  SNP / Medicaid Advantage / Special Needs Plan (HMO-SNP)
Monthly Premium:
Geographic Coverage:   Orange County
Monthly Premium:
PCP Copay: $0 copay1
Specialist Copay: $0 copay1
Includes: Over the Counter Benefits

More Info  More Information
In-Network Out-of-Pocket Maximum: $3400 In-Network
Inpatient Hospital Care2: $0 yearly deductible1; $0 copay1
Coverage in Coverage Gap: Generics1 - $0 copay; or $1.20 copay; or $2.55 copay
Brand1 - $0 copay; or $3.60 copay; or $6.35 copay
Tier 1 (Generic) Copay5: $0 copay; or $1.20 copay; or $2.55 copay1
Tier 2 (Preferred Brand) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
Tier 3 (Non-Preferred Brand) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
Tier 4 (Specialty Tier Drugs) Copay5: $0 copay; or $3.60 copay; or $6.35 copay1
 
Other Benefits
Preventive Dental Services: $0 copay1
Routine Hearing Exam4: $0 copay1
Routine Eye Exam4: $0 copay for routine1
Over the Counter Benefit: get $45 per month
Transportation: $0 copay for up to 36 one way trip(s) to plan-approved location every year
Fitness: yes
Complementary Alternative Medicine: yes
Brain Games: yes
Other Benefits:
1 Based on your level of Medicaid eligibility.
2 Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
3 $0 copay for additional hospital days.
4 Up to 1 routine exam / yr.
5 Based on supply for one month (30-day) retail pharmacy.
6 Members should review their Summary of Benefits for details on coverage depending on Medicaid eligibility.
 
To discuss Touchstone Health’s Medicare Advantage plan options with a live representative or to schedule a home appointment, call: