Flex (RPPO) Plan 2020

Generations Advantage Flex (RPPO) is designed for those looking for a health care plan with more flexibility. With this plan, you get complete medical, hospital, and Part D Prescription Drug coverage and you can see out-of-network doctors for all covered medical services, though you pay less for in-network and in-service-area doctors. The Flex plan is available throughout the service area of Maine and New Hampshire.
 

Your Area

Flex Benefits

Costs

  • Please enter your Zip Code above to see your plan premium.
    • No medical or hospital deductibles
    • $275 Part D prescription deductible for Tiers 3– 5 drugs only
    • $0 annual routine physical (30% out-of-network)
    • $0 annual routine vision exam (30% out-of-network)
    • $0 copays for primary care office visits (30% out-of-network)
    • $0 copays for a range of preventive services when you see an in-network provider
    • $45 copays for specialist visits (30% out-of-network)
    • $2 copays for many generics at Hannaford Pharmacies1
    • $0 for generic drugs through the mail-order pharmacy benefit

    Maximum Out-of-Pocket

    • Get peace of mind with a predictable limit on costs, even in the case of a serious health problem.
    • $5,500 for in-network services ($8,000 combined in- and out-of-network)
    • Your plan premium and prescription drug copayments don't count toward this maximum.

Features

  • Part D Prescription Drug coverage (see if your drugs are covered)
  • Emergency care coverage worldwide
  • Urgent care coverage nationwide
  • Large network of doctors across Maine and New Hampshire (see if your doctor is in-network)
  • Out-of-network flexibility: option of getting all services outside the network, but you will generally pay more for these services2
  • Over-the-counter (OTC): Up to $50 quarterly for members to purchase select CVS-brand, over-the-counter items
  • Wellness Wallet: Up to $200 reimbursed each year in total for eyewear, dietary/nutrition, fitness benefit, naturopathic services, acupuncture, and weight management programs
  • Hearing aids: $595/$695/$895 copay per ear, depending on tier selected (no copays for fittings or evaluations)
  • Flu shots: Get your annual flu shot3 at no cost, either at your primary care provider’s office (who may charge an office visit copay) or a participating pharmacy.4

Comprehensive Dental Benefits

  • No waiting periods for coverage
  • $50 office visit copay
  • $1,000 benefit maximum (in- and out-of-network combined)
  • In-Network: See a Delta Dental PPO/Martin’s Point Generations Advantage network dentist in Maine, New Hampshire, or Vermont.
  • Out-of-Network: See any out-of-network dentist, cost shares differ.
  • Diagnostic and preventive services include cleanings, exams, and X-rays: In-network—fully covered with no coinsurance/deductible; Out-of-network—covered at 50% with no deductible.
  • Basic restorative services include fillings, oral surgery, root canals, and periodontal maintenance: In-network—covered with 50% coinsurance and a one-time $50 deductible; Out-of-network—covered with 75% coinsurance and a one-time $50 deductible.
  • Major restorative services include dentures, bridges, crowns, onlays, and implants: In-network—covered with 50% coinsurance and a one-time $50 deductible; Out-of-network—covered at 75% coinsurance and a one-time $50 deductible.
 
ENROLL NOW
Have questions? We’re here to help.

Talk to a health plan specialist 8 am–8 pm, Monday - Friday.

Enroll:
1-800-603-0652 
(TTY: 711)

Current Members:
1-866-544-7504

Plan Benefit Details and Documents
Additional Resources

Part D Prescription Drug Copayments

$275 Prescription deductible for Tiers 3–5 drugs only

Tier 1 2 3 4 5
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $2 $10 $40 $95 28% of cost
Pharmacies with Standard cost sharing, 30-day supply* $4 $18 $47 $100 28% of cost
Mail-order, 90-day supply $0 $20 $100 $237.50 28% of cost
*For 90-day supply cost, multiply by three.

 

Ready to enroll? Let’s get started

Find out how to enroll in your plan choice and what documentation you’ll need to complete your online enrollment.
1At pharmacies with preferred cost-sharing, you pay $2 for Cost-Sharing Tier 1 (preferred generic drugs and certain preferred brand name drugs). Other pharmacies are available in our network.
2Out-of-network/non-contracted providers are under no obligation to treat Flex plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
3Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Flex and costs do not count toward your Part D drug spend or out-of-pocket costs.
4The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.

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