2019BENEFIT HIGHLIGHTS2020BENEFIT HIGHLIGHTS
BND_8876
Brand New Day Embrace Care Plan (HMO CSNP) 39-2
Brand New Day Embrace Choice Plan (HMO CSNP) 40-2
H0838_1422.2020Hilit.39.2.40.2. 191111_M
PLAN DETAILSBRAND NEW DAY
EMBRACE CARE PLAN (HMO CSNP) 39-2
BRAND NEW DAYEMBRACE CHOICE PLAN
(HMO CSNP) 40-2
Monthly Plan Premium
Deductible Maximum Out-of-Pocket (MOOP)
$0
No Deductible
You pay no more than $999
$32
No Deductible
You pay no more than $6,700
COMPREHENSIVE PLAN 39-2PLAN 40-2
Medi-Cal will pay the following cost-shares for you if you remain
eligible and have no share of cost.
Primary Care Providers
Specialists1
Endocrinologist1
Urgently Needed Services
Diagnostic tests and procedures1
Lab Services1
MRI, CAT Scan1
X-rays1
Therapeutic Radiology1
Durable Medical Equipment1
Prosthetics / Medical Supplies1
Diabetic Supplies1
Diabetic Shoe Inserts1
Physical Therapy1
Occupational Therapy1
Dialysis1
Podiatry Services1
$0 copay
$10 copay$0 copay
$0 per visit
$0 copay
$0 copay $0 copay $0 copay
20% of the cost
$0 copay for items less than $10020% of the cost for items over $100
$0 copay for items less than $100 20% of cost for items over $100
$0 copay
$0 copay
$10 copay
$10 copay
20% of the cost
$0 copay
20% of the cost
20% of the cost20% of the cost
$0 per visit
20% of the cost
$0 copay20% of the cost20% of the cost20% of the cost
20% of the cost
20% of the cost
$0 copay
$0 copay
$40 copay
$40 copay
20% of the cost
20% of the cost
1Services may require authorization and/or a referral2Copayment/share of cost waived if you are admitted to a hospital within 72 hours.
3Emergency transportation must be provided by a licensed emergency transportation vehicle.1Services may require authorization and/or a referral2Copayment/share of cost waived if you are admitted to a hospital within 72 hours.
HOSPITAL & EMERGENCY CARE
BRAND NEW DAY EMBRACE CARE PLAN
(HMO CSNP) 39-2
BRAND NEW DAYEMBRACE CHOICE PLAN
(HMO CSNP) 40-2Medi-Cal will pay the following
cost-shares for you if you remain eligible and have
no share of cost.
Inpatient Hospital1
Outpatient Hospital1
Emergency Care2 Worldwide Emergency3
Ambulance
$100 copay for days 1-4 $0 copay for days 5-90
$75 copay for surgery and $100 copay for other services
$100 per visit$0 copay
$125 copay per ride
$1,340 Deductible$0 copay for days 1-60
$335 copay per day for days 61-90
20% of the cost for surgery and20% of the cost for other services
$90 per visit20% of the cost
20% of the cost
PRESCRIPTION DRUG COVERAGE PLAN 39-2
PLAN 40-2If you receive “Extra Help”
to pay your prescription drugs, this payment stage does not
apply to you.
Part D Deductible
Initial Coverage Tier 1- Preferred GenericTier 2 - GenericTier 3 - Preferred BrandTier 4 - Non-Preferred DrugTier 5 - Specialty TierTier 6 - Select Care Drugs
You are in the Initial Coverage stage until you reach $4,020 in drug costs (year to date).
Coverage GapYou stay in this stage until your year-to-date “out-of-pocket costs” (your payments) reach a total of $6,350.
No Deductible
Retail Rx 30-day Supply$0 copay$12 copay$47 copay$90 copay
33% of the cost$0 copay
$0 copay for Tier 1 – Preferred Generic and Tier - 6 Select Care
Drugs during this stage.
For all other tiers, you pay 25% of the cost for brand name drugs (plus a portion of the dispensing
fee) and 25% of the cost for generic drugs.
$435You don’t pay a deductible for Tier 1 - Preferred Generic and
Tier - 6 Select Care Drugs
Retail Rx 30-day Supply$0 copay
25% of the cost25% of the cost25% of the cost25% of the cost
$0 copay
25% of the cost for brand name drugs (plus a portion of the
dispensing fee) and 25% of the cost for generic drugs.
ADDITIONAL BENEFITS & SERVICES
BRAND NEW DAY EMBRACE CARE PLAN
(HMO CSNP) 39-2
BRAND NEW DAYEMBRACE CHOICE PLAN
(HMO CSNP) 40-2
Routine Eye Exam
Frames and lenses or Contacts
Oral exam and cleaning
$0 copay, one exam per year
$175 allowance every year towards your purchase
$0 copay for oral exams up to 2 per year
$0 copay every 6 months for cleanings, up to 2 per year$55 copay if more frequent
$0 copay, one exam per year
$175 allowance every year towards your purchase
$0 copay for oral examsup to 2 per year
$0 copay for cleanings up to 2 per year
Hearing AidYou must call TruHearing to use this benefit
Transportation1
Over-The-Counter (OTC) Items
Viagra
Chiropractic1
Acupuncture1
$699 per aid for theAdvanced Model
$999 per aid Premium Model2 hearing aids per year
$0 copay unlimited plan-approved trips
$50 allowance every three (3) months for OTC supplies
$12 copay
$0 copay
Not Covered
$149 per aid for the Advanced Model
2 hearing aids every 3 years
$0 copay unlimited plan-approved trips
$40 allowance every three (3) months for OTC supplies
25% of the cost
$0 copay
$0 copay24 treatments
WELLNESS PROGRAMS PLAN 39-2 PLAN 40-2
Gym Membership1
Personal Care Plan1
$0 copay
$0 copay
$0 copay
$0 copay
3Emergency transportation must be provided by a licensed emergency transportation vehicle.
Brand New Day Embrace Care Plan (HMO CSNP) 39-2 is a good choice for anyone who doesn’t qualify for Medi-Cal with a diagnosis of Cardiovascular Disease and or Diabetes. This plan reduces the cost of prescription drugs while adding additional services and benefits.
• For Fresno, Imperial, Kings, San Mateo, Santa Clara, and Tulare Counties
Brand New Day Embrace Choice Plan (HMO CSNP) 40-2 is a good choice for individuals who require assistance coordinating with other health insurance coverage. An individual can qualify for this plan with a diagnosis of Cardiovascular Disease and or Diabetes.
• For Fresno, Imperial, Kings, San Mateo, Santa Clara, and Tulare Counties
THERE ARE TWO DIFFERENT HEALTH INSURANCE BENEFIT PLANS. FIND THE ONE THAT IS RIGHT FOR YOU:
Brand New Day is an HMO SNP with a Medicare Contract. Enrollment in Brand New Day depends on contract renewal. Calling the agent/broker number will direct an individual to a licensed insurance agent/broker. For accommodations of persons with special needs at meetings call 1-866-255-4795, TTY 711. You must continue paying your Medicare Part B premium.
P.O. Box 93122 Long Beach, CA 90809-9871 1-866-255-4795 | TTY 711
WWW.BNDHMO.COM
CALL TO CONTACT AN AUTHORIZED BRAND NEW DAY REPRESENTATIVE TODAY!
Phone 1-866-255-4795TTY 711
Or visit us at www.bndhmo.com
Hours:Year RoundMonday - Friday, 8 am - 8 pmOctober 1 - March 31Monday - Sunday, 8 am - 8 pm