H0838_1421.2020Hilit.39.1.40.1.191111_MH0838_1425.2020Hilit.25.33.191112_M

Brand New Day Embrace Care Plan (HMO CSNP) 39-1

Brand New Day Embrace Choice Plan (HMO CSNP) 40-1

2021 BENEFITHIGHLIGHTS

H0838_2317.201116_M BND_9524

Discover the benefits of Brand New Day. Find the plan that’s right for you.

Brand New Day is an HMO SNP with a Medicare Contract. Enrollment in Brand New Day depends on contract renewal. This information is available in other formats, such as large print, and audio. 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.

Brand New Day Embrace Care Plan (HMO CSNP) 39-1 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 Kern, Los Angeles, Orange, Riverside, San Bernardino, and San Diego Counties

Brand New Day Embrace Choice Plan (HMO CSNP) 40-1 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 Kern, Los Angeles, Orange, Riverside, San Bernardino, and San Diego Counties

PLAN DETAILSBRAND NEW DAY

EMBRACE CARE PLAN (HMO CSNP) 39-1

BRAND NEW DAYEMBRACE CHOICE PLAN

(HMO CSNP) 40-1

Monthly Plan Premium

Deductible Maximum Out-of-Pocket (MOOP)

$0

No Deductible

You pay no more than $999

$31.50

No Deductible

You pay no more than $7,550

COMPREHENSIVE PLAN 39-1PLAN 40-1

Medi-Cal will pay the following cost-shares for you if you remain

eligible and have no share of cost.

Primary Care Providers

Specialists1

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

$0 copay

$0 per visit

$0 copay

$0 copay $0 copay $0 copay

20% of the cost

$0 copay for items less than $100 20% of the cost for items over $100

$0 copay for items less than $10020% of the cost for items over $100

$0 copay

$0 copay

$10 copay

$10 copay

20% of the cost

$0 copay

20% of the cost

$0 copay for surgery20% of the cost for other services

$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

1 Services may require authorization and a referral.2 Copayment/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) 39-1

BRAND NEW DAYEMBRACE CHOICE PLAN

(HMO CSNP) 40-1Medi-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

No Deductible $0 copay for days 1-90

$0 copay for surgery

$100 per visit$0 copay

$75 copay per ride

For 2020 the cost-shares were:4

$1,408 Deductible $0 copay for days 1-60

$352 copay per day for days 61-90

20% of the cost for surgery

$90 per visit20% of the cost

20% of the cost per ride

PRESCRIPTION DRUG COVERAGE PLAN 39-1

PLAN 40-1If you receive “Extra Help” to

pay your prescription drugs, this payment stage does not apply

to you.

Part D Deductible

Initial CoverageTier 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 $4,130 in drug costs year-to-date.

Senior Savings Model5Insulin drugs covered on: Tier 2 - Generic Tier 3 - Preferred Brand

Coverage GapYou stay in this stage until your year-to-date “out-of-pocket costs” (your payments) reach a total of $6,550.

No Deductible

Retail Rx 30-day Supply$0 copay$9 copay$47 copay$90 copay

33% of the cost$0 copay

$9 copay$20 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.

$445You 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

Not CoveredNot Covered

25% of the cost for brand name drugs (plus a portion of the

dispensing fee) and 25% of the cost for generic drugs.

3 Emergency transportation must be provided by a licensed emergency transportation vehicle.4 These amounts may change for 2021. Brand New Day will provide updated rates as soon as Medicare releases them.5 Senior Savings Model coverage for insulins are covered through the Coverage Gap.

ADDITIONAL BENEFITS & SERVICES

BRAND NEW DAY EMBRACE CARE PLAN

(HMO CSNP) 39-1

BRAND NEW DAYEMBRACE CHOICE PLAN

(HMO CSNP) 40-1Annual Eye Exam

Frames

Standard Lenses

Oral exam and cleaning

$0 copay

Spend up to $175

$0 copay

$0 copay every 6 months for oral exams, up to 2 per year

$0 copay every 6 months for cleanings, up to 2 per year$50 copay if more frequent

$0 copay

Spend up to $175

$0 copay

$0 copay for oral examsup to 2 per year

$0 copay for cleaningsup to 1 per year

Hearing AidYou must call TruHearing to use this benefit

Transportation1

Over-The-Counter (OTC) Items

Viagra

Chiropractic1

Acupuncture1

$499 per aid for the Advanced Model

$799 per aid Premium Model2 hearing aids per year

$0 copayunlimited plan-approved trips

$250 allowance every six (6) months for OTC supplies

$9 copay

$0 copay30 treatments combined with

Acupuncture services

$0 copay30 treaments combined with

Chiropractic services

$149 per aid for the Advanced Model

2 hearing aids every 3 years

$0 copayunlimited plan-approved trips

$200 allowance every three (3) months for OTC supplies

25% of the cost

$0 copay30 treatments combined with

Acupuncture services

$0 copay30 treaments combined with

Chiropractic services

WELLNESS PROGRAMS PLAN 39-1 PLAN 40-1

Gym Membership

Personal Care Plan

Healthy Foods Monthly Allowance

$0 copay

$0 copay

Not Covered

$0 copay

$0 copay

$30 monthly allowance to buy whole foods at

approved grocery stores

Call to contact an authorized Brand New Day representative today!

P.O. Box 93122 Long Beach, CA 90809-9871 1-866-255-4795 | TTY 711

WWW.BNDHMO.COM

Call Toll-Free1-866-255-4795TTY 711

Visit our Websitewww.bndhmo.com

Hours of OperationMonday - Friday, 8 am - 8 pmfrom April 1 - September 30 7 days a week, 8 am - 8 pm from October 1 - March 31