SILVERSUMMIT HEALTH PLAN-HEALTH CARE …

1 SILVERSUMMIT HEALTH plan - HEALTH care services information NMO-5001N (E) (01/18) MCO Medical Benefits Hospitals Value-Added Benefits Obstetrical Provider Access Pharmacy Urgent care Mental HEALTH services (North) No copay - Covered at 100% Birth Control/Family Planning Early Periodic Screening and Diagnostic Treatment (EPSDT)/Healthy Kids Chiropractic (under age 21) Durable Medical Equipment Doctor Visits Specialists Hearing Tests Hospital care Emergent/Urgent care Maternity care Midwife services Preventative Screenings Immunizations Nursing Home services Private Duty Nursing Home HEALTH care Occupational Therapy services Orthotics & Prosthetics Physical Therapy services This is not a complete list of all benefits offered It s important that you have a choice in where you go for healthcare. We are offering and encouraging all hospitals in the Reno area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible.

2 View the complete and most updated list of hospitals in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086). This list will be updated often as we add to our network. Vision- Preventive eye exams and repair or replacement of eyeglasses 1 per year for all ages. Rewards Program - Earn dollars on a pre-paid card for healthy behaviors. Pregnancy Program Educational material, breastfeeding support including breast pump, baby showers and more! No Cost Cell Phone through SafeLink. SILVERSUMMIT members get unlimited texting and discounts on additional minutes above 250/month. Weight Watchers Membership Vouchers (Conditions may apply) It s important that you have a choice in where you go for healthcare. We are offering and encouraging all providers in the Reno area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible. View the complete and most updated list of providers in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086).

3 This list will be updated often as we add more providers to our network. No copay - Covered at 100% Enhanced over the counter benefit - $30 per household each quarter. Medications 34 day retail supply 100 day supply for maintenance medications Smoking cessation medications covered Pharmacy Network includes major drugstore chains and many independent pharmacies: CVS Kmart Safeway Sams Save-On Smiths Target Wal-Mart Walgreens No copay - Covered at 100% It s important that you have a choice in where you go for healthcare. We are offering and encouraging all urgent care centers in the Reno area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible. View the complete and most updated list of urgent care centers in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086). This list will be updated often as we add to our network. Mental HEALTH /Substance Abuse services Outpatient Mental HEALTH Rehabilitative Mental HEALTH Day Treatment Electroconvulsive Therapy Applied Behavioral Analysis Outpatient Alcohol and Substance Abuse services Inpatient Mental HEALTH Inpatient Alcohol and Substance Abuse Detox and Treatment Residential Treatment Center care and Disease Management special programs for ADHD, anxiety, bipolar & schizoaffective, depression, perinatal depression, and perinatal substance use.

4 24 Hour Access to care and Experts 24/7 Crisis and Nurse Advice Lines. (South) No copay - Covered at 100% Birth Control/Family Planning Early Periodic Screening and Diagnostic Treatment (EPSDT)/Healthy Kids Chiropractic (under age 21) Durable Medical Equipment Doctor Visits Specialists Hearing Tests Hospital care Emergent/Urgent care Maternity care Midwife services Preventative Screenings Immunizations Nursing Home services Private Duty Nursing Home HEALTH care Occupational Therapy services Orthotics & Prosthetics Physical Therapy services This is not a complete list of all benefits offered It s important that you have a choice in where you go for healthcare. We are offering and encouraging all hospitals in the Las Vegas area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible. View the complete and most updated list of hospitals in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086).

5 This list will be updated often as we add to our network. Vision- Preventive eye exams and repair or replacement of eyeglasses 1 per year for all ages. Rewards Program - Earn dollars on a pre-paid card for healthy behaviors. Pregnancy Program Educational material, breastfeeding support including breast pump, baby showers and more! No Cost Cell Phone through SafeLink. SILVERSUMMIT members get unlimited texting and discounts on additional minutes above 250/month. Weight Watchers Membership Vouchers (Conditions may apply) It s important that you have a choice in where you go for healthcare. We are offering and encouraging all providers in the Las Vegas area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible. View the complete and most updated list of providers in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086). This list will be updated often as we add more providers to our network. No copay - Covered at 100% Enhanced over the counter benefit - $30 per household each quarter.

6 Medications 34 day retail supply 100 day supply for maintenance medications Smoking cessation medications covered Pharmacy Network includes major drugstore chains and many independent pharmacies: CVS Kmart Safeway Sams Save-On Smiths Target Wal-Mart Walgreens No copay - Covered at 100% It s important that you have a choice in where you go for healthcare. We are offering and encouraging all urgent care centers in the Las Vegas area to contract with SILVERSUMMIT . Our goal is to offer our members the most robust network possible. View the complete and most updated list of urgent care centers in our network at or call 1-844-366-2880 (TTD/TTY 1-844-804-6086). This list will be updated often as we add to our network. Mental HEALTH /Substance Abuse services Outpatient Mental HEALTH Rehabilitative Mental HEALTH Day Treatment Electroconvulsive Therapy Applied Behavioral Analysis Outpatient Alcohol and Substance Abuse services Inpatient Mental HEALTH Inpatient Alcohol and Substance Abuse Detox and Treatment Residential Treatment Center care and Disease Management special programs for ADHD, anxiety, bipolar & schizoaffective, depression, perinatal depression, and perinatal substance use.

7 24 Hour Access to care and Experts 24/7 Crisis and Nurse Advice Lines. SILVERSUMMIT HEALTH plan -INFORMACI N DE SERVICIOS DE SALUD NMO-5001N (S) (01/18) MCO Beneficios M dicos Hospitales Beneficios de valor agregado Acceso a proveedores de obstetricia Farmacia Atenci n Urgente Servicios de Salude Mental (Norte) Sin copago - Cubierto al 100% Control de la natalidad/Planificaci n familiar Detecci n, Diagn stico y Tratamiento Temprano y Peri dico (Early and periodic screening and diagnostic treatment) (EPDST)/Healthy Kids Quiropr ctico (menores de 21 a os) Equipo m dico duradero Visitas al m dico Especialistas Pruebas de audici n Atenci n hospitalaria Atenci n de emergencia/urgente Atenci n de maternidad Servicios de partera Evaluaciones preventivas Inmunizaciones Servicios de instituci n geri trica o para convalecientes Enfermer a privada Atenci n de salud en el hogar Servicios de terapia ocupacional Ort tica y prot tica Servicios de fisioterapia Esta no es una lista completa de todos los beneficios que se ofrecen Es importante que tenga una opci n en cuanto a d nde ir para atenci n m dica.

8 Estamos ofreciendo y alentando a todos los hospitales en al rea de Reno a que contraten con SILVERSUMMIT . Nuestra meta es ofrecer a nuestros miembros la red m s robusta posible. Vea la lista completa y m s actualizada de hospitales en nuestra red en o llame al 1-844-366-2880 (TTD/TTY 1-844-804-6086). Esta lista se actualizar con frecuencia conforme a adamos a nuestra red. Vista- Ex menes preventivos de los ojos y reparaci n o reemplazo de anteojos, 1 por a o para todas las edades. Programa de recompensas - Gane d lares en una tarjeta prepagada para comportamientos saludables Programa para el embarazo Material educativo, apoyo para la lactancia materna incluso una bomba para la extracci n de leche, baby showers y m s! Tel fono celular sin costo a trav s de SafeLink. Los miembros de SILVERSUMMIT reciben textos ilimitados y descuentos en minutos adicionales por encima de 250/mes. Cupones para inscripci n en Weight Watchers (pueden aplicar condiciones) Es importante que tenga una opci n en cuanto a d nde ir para atenci n m dica.

9 Estamos ofreciendo y alentando a todos los proveedores en al rea de Reno a que contraten con SILVERSUMMIT . Nuestra meta es ofrecer a nuestros miembros la red m s robusta posible. Vea la lista completa y m s actualizada de proveedores en nuestra red en o llame al 1-844-366-2880 (TTD/TTY 1-844-804-6086). Esta lista se actualizar con frecuencia conforme a adamos m s proveedores a nuestra red. Sin copago - Cubierto al 100% Beneficio mejorado de venta sin receta - $30 por hogar cada trimestre Medicamentos Suministro minorista para 34 d as Suministro de 100 d as para medicamentos de mantenimiento Medicamentos para dejar de fumar cubiertos La Red de farmacias incluye cadenas principales de farmacias y muchas farmacias independientes: CVS Kmart Safeway Sams Save-On Smiths Target Wal-Mart Walgreens Sin copago - Cubierto al 100% Es importante que tenga una opci n en cuanto a d nde ir para atenci n m dica. Estamos ofreciendo y alentando a todos los centros de atenci n urgente en al rea de Reno a que contraten con SILVERSUMMIT .

10 Nuestra meta es ofrecer a nuestros miembros la red m s robusta posible. Vea la lista completa y m s actualizada de centros de atenci n urgente en nuestra red en o llame al 1-844-366-2880 (TTD/TTY 1-844-804-6086). Esta lista se actualizar con frecuencia conforme a adamos a nuestra red. Servicios de salud mental/abuso de sustancias Salud mental para pacientes ambulatorios Salud mental para rehabilitaci n Tratamiento durante el d a Terapia electroconvulsiva An lisis aplicado del comportamiento Servicios para abuso de alcohol y sustancias para pacientes ambulatorios Salud mental para pacientes internados Desintoxicaci n y tratamiento para el abuso de alcohol y sustancias para pacientes internados Centro residencial de tratamiento Manejo de la atenci n y enfermedades programas especiales para ADHD, ansiedad, trastorno bipolar y esquizoafectivo, depresi n, depresi n perinatal y abuso perinatal de sustancias. Acceso las 24 horas a atenci n y expertos L neas de crisis y consejo de enfermer a que atienden 24/7.