Valor Health Plan HMO Special Needs Plan with Prescription Drug for Institutional Residents (2024)
The Valor Advantage
- Low Cost Premium $40.90 premium for medical coverage
- Physical, Occupational and Speech Therapy No annual limit
- Skilled Nursing Care No prior hospital stay requirement
- All-In-One Plan Covers original Medicare benefits plus Medicare Part D prescription drugs
- Over-the-Counter (OTC) Benefit $107 per quarter OTC benefit (remains $107)
- Local Care Team Hands-on RNs and Nurse Practitioners to assist with quality care coordination
| Summary of Important Costs | |
|---|---|
| Monthly Premium | $40.90 |
| Primary Care Visit | 20% per visit |
| Specialist Visit | 20% per visit |
| Inpatient Hospital Stays |
$1,632 deductible for days 1 – 60 $408 copay per day for days 61 – 90 $816 copay per lifetime reserve day |
| Part D Prescription Drugs |
Standard Benefit Coinsurance during the Initial Coverage Stage: 25% |
Last Updated October 01, 2024
Enrollment Process
Enroll in a Medicare Advantage Special Needs Plan that’s right for you. Our dedicated licensed agents are here to guide you through the enrollment process. Simply call 1-800-485-3793 and set up an appointment to begin the enrollment process.
Valor Health Plan also accepts enrollment forms by fax or mail.
Once we confirm your eligibility with Medicare, you can expect to receive a confirmation letter by mail, identification card and your new member mailing within 10 days.
Call Member Services (available 8am – 8pm) at 1-800-485-3793.
Last Updated October 01, 2024
Formulary
Online Prior Authorization
Comprehensive Formulary
– Last Updated 11/01/2024
Formulary Step Therapy Criteria
– Last Updated 11/01/2024
Formulary Prior Authorization Criteria
– Last Updated 11/01/2024
Redetermination Request Form
Coverage Determination Request Form
Online Formulary Search Tool
Other Resources
Pharmacy Search
Medication Transition Policy
Medication Therapy Management
Safe Disposal
Last Updated November 01, 2024
Resources
Appeals and Grievances
Extra Help/Low Income Subsidy
Over-the-Counter (OTC) Catalog
Appointment of Representative Form
Medicare Complaint
Criteria for Medicare Coverage
Last Updated October 01, 2024