Vitality for Life.

2019 BENEFIT HIGHLIGHTS

Medicare Advantage HMO with Prescription Drugs

San Joaquin County Santa Clara County

H1426_19_077_MK_ENG_M Approved

�����!DMDkS Highlights

page 2 Vitality Choice (HMO) Vitality Choice (HMO) Vitality Plus (HMO)

Service Area

Must reside in San Joaquin County

Must reside in Santa Clara County

Must reside in San Joaquin County or

Santa Clara County

Other Eligibility Requirements

Must have Medicare Part A and Part B

Must have Medicare Part A and Part B

Must have Medicare Part A and Part B

Maximum Out of Pocket $3,200 $3,200

$6,700 For some people this may be paid in part or in full by Medicaid or a third party

Part C Monthly Premium $0 $0 $0

Part D Monthly Premium $0 $0

$34.80* For some people this may be paid in part or in full by Medicaid or a third party

*Part D Monthly Premium may vary based on the level of Extra Help you receive

�����!DMDkS Highlights

page 3

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Nurse Advice Hotline $0 $0 $0

Primary Care .EkBD�5HRHS $0 $0 $0

Specialist .EkBD�5HRHS $0 $0 $0

Rehabilitation Services

(Physical, Speech, Occupational Therapy)

$0 $0

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Lab Work $0 $0 $0

�����!DMDkS Highlights

page 4

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Diabetes Supplies $0 $0 $0

X-Rays $0 $0

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Complex Diagnostics

(MRI, CT-Scan) $50 $0

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Home Health Care $0 $0 $0

Urgent Care 5HRHS $15 $0

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

�����!DMDkS Highlights

page 5

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Ambulance Services

$100 (Waived if admitted

within 24 hours)

$100 (Waived if admitted

within 24 hours)

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Emergency 1NNL�5HRHS

$75 (Waived if admitted)

within 24 hours

$90 (Waived if admitted)

within 24 hours

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Inpatient Hospitalization

(Acute Care)

$0 per day, days 1–90, ($0 unlimited

additional days)

$0 per day, days 1–90, ($0 unlimited

additional days)

$1,364 deductible*days 1–60;

$341 per day, days 61–90;*

Skilled Nursing Facility

(no prior hospital stay required)

$0 per day, days 1–20; $50 per day, days 21–75; $75 per day, days 76–100

$0 per day, days 1–20; $50 per day, days 21–75; $75 per day, days 76–100

$0 per day, days 1–20; $170.50 per day,

days 21–100*

Inpatient Mental Health

$100 per day, days 1–16, $0 for days 17–90

$200 per day, days 1–8, $0 for days 9–90

$1,364 deductible*days, 1–60;

$341 per day, day 61–90;*

*For people with full Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party. Cost share may change in 2019.

�����!DMDkS Highlights

page 6

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Outpatient Mental Health

5HRHSR� $15 $25

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Outpatient Surgery at

Ambulatory Surgical Center

$50 $50

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Hospital Outpatient Services &

Diagnostics

$75 $75

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Durable Medical Equipment 20% 20%

20% For people with full

Medicaid, this coinsurance may be paid in part or in full by Medicaid or a third party

Routine Hearing Exam $0 $0 $0

�����!DMDkS Highlights

page 7

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Hearing Aid Allowance

$1,000 Limit every year

$1,000 Limit every year

$1,000 Limit every year

Routine Acupuncture NQ�"GHQNOQ@BSNQ�5HRHSR

$0 Up to 15 annual combined visits

$0 Up to 15 annual combined visits

$0 Up to 15 annual combined visits

Fitness Membership with

Silver & Fit

$0 Annual membership

with multiple locations

$0 Annual membership

with multiple locations

$0 Annual membership

with multiple locations

Transportation to Plan Approved

Providers

$0 22 one–way trips

Annually

$0 28 one–way trips

Annually

$0 Unlimited one–way trips

Annually

Annual Maximum On Worldwide

Coverage

$50,000 per year for emergency or

urgently needed care while outside the United States

$50,000 per year for emergency or

urgently needed care while outside the United States

$50,000 per year for emergency or

urgently needed care while outside the United States

�����!DMDkS Highlights

page 8

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Routine Eye Exam

and Refraction

$0 (1 every year)

$0 (1 every year)

$0 (1 every year)

Eyewear Frames EQNL�52/

Genesis Collection

Free Once every 24 months

Free Once every 24 months

Free Once every 24 months

Single lens, Bifocal, Trifocal, Lenticular or

Standard Progressive Lens

Free Once every 24 months

Free Once every 24 months

Free Once every 24 months

Photochromic and Polycarbonate Lens

Upgrades

Free Once every 24 months

Free Once every 24 months

Free Once every 24 months

UV Coating, A nti-Reflective, and

Scratch Resistant Lenses

Free Once every 24 months

Free Once every 24 months

Free Once every 24 months

�����!DMDkS Highlights

page 9

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Tier 1 – Preferred

Generic Drugs 30 Day Supply

$0 $0 $0

Tier 2 – Generic Drugs 30 Day Supply

$5 $5

$0, $1.25, $3.40, or 15% based on low income subsidy. Or 25% if no low income

subsidy exists

Tier 3 – Preferred

Brand Drugs 30 Day Supply

$35 $35

$0, $3.80, $8.50, or 15% based on low income subsidy. Or 25% if no low income

subsidy exists

Tier 4 – Non-Preferred Brand Drugs

30 Day Supply

$90 $90

$0, $3.80, $8.50, or 15% basedon low income subsidy. Or 25% if no low income

subsidy exists

Tier 5 – Specialty Drugs 30 Day Supply

33% coinsurance

33% coinsurance

$0, $3.80, $8.50, or 15% based on low income subsidy. Or 25% if no low income

subsidy exists

�����!DMDkS Highlights

page 10

Vitality Choice (HMO) San Joaquin County

Vitality Choice (HMO) Santa Clara County

Vitality Plus (HMO) San Joaquin County

& Santa Clara County

Prescription Drug Coverage in the Gap

Tier 1 Tier 2

Tier 1 Tier 2 Tier 1

Catastrophic Coverage

After yearly out-of-pocket costs reach $5,100, you pay the greater of: 5% of the cost,

or $3.40 for generic (including brand drugs treated as generic) and $8.50 for all other drugs

2HKCDM@kK�"HSQ@SD (Erectile Dysfunction)

prescription medication

Tier 2 Copay (6 tablets per 30 days)

Tier 2 Copay (6 tablets per 30 days)

Tier 2 Copay (6 tablets per 30 days)

Over-The-Counter (OTC) Items Allowance

$40 Quarterly

$40 Quarterly

$60 Quarterly

Comprehensive Dental Coverage

$0 Monthly Premium (Please see Dental Plan Fee Schedule Insert)

�

zpt ± µ��utht ± ± ± ± a³��f{�r{w ± ± atzz�xby¡{�� }htzvt¡ax�k£zytcpit|�cfyt{uu{t r ±{ ʸƖʿʽu

���� �Ɠ���Ž�Ê¿·É�ÁÅÀ�¾·¿É�ÂËÉ��ÃÅŸƑ�¹ÅÌ�Á»Ì�Æ·¸�ÊÎŽ�ÂËÉƑ�ÃË·À�Á»Ì�Æ·¸�º·Í¸�È·Ë�ÁÅÀƔ�����Ë�È·Ë�ʸƖʿʽʽƖʺʺʺƖʺʼ

pa·*aw a awa a +a aa ¬ua²a a | a±a a³a ¾y ƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻaQ a¹a¹ ¾

ʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ³

�� ʺʷ�ƺ���Ɠ�ʾʸy ƻƔ

धयTन द : यदf आप हf दT बTलत ह ं

e तT आपक लfए मफत म भTषT सहTयतT स वTए उपलबध ह l ं ं ं ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ पर कTल कर l ं

ǩǏ ǛLjȥ��ƯǥǁNjǟDŽưǥǚǥǫdžǛǁNjǗǥljǥǏƯǬƿǘǏ ƮǥǏƿǑǛǩǠǖ ǣdžǥǒưǥǚǥǫDŽǞǏ ��ǭdžǏ ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ.

ӥҗӡөƓ�ʾʸy ƻƔҕӭƔ��ҕҝӁӥ�җҵӝө�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺҵӝө�ӱҕҝә�ҕӥӁө�Ӷҕәҵ�ӥӡ�җҕӥөҥҕӭ�ҭұөҕҝ�ҕӥөҹҕӑұқ�ҕӥӥӕӶӼқ�ҝҝӶҏ܃�әөӥҩӶӍқƓ��ҏҳҕ�ӡӭҝ�ҝҝҩұҡ�ҕҳӡҵ�ҕӥӥӕқ

岤䠑㥵卓䝠⢪欽籖넒⚥俒䝠〳⟄⯝顥格䖤铃鎊䴂⸔剪կ锝荝ꨵ� y ƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ�կ�

���ªƓ���öË�¸æÄ�ÄĤ¿��¿öĽ��¿ùÊƑ�¹Ĥ�¹Ò¹�ºē¹¾�Ìŕ�¾Ĩ�ÊÈķ�ĽĥÄ�Ľř�ÿ÷Ä�ƾċ�ºÑľ�¹¾Å�¸æÄƔ��ı¿�Éħ�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻƔ�

�������Ɠ���ËĽ�Ä·½É·É·Â¿Ê·�Á·�Ľ��·½·ÂŽƑ�÷··È¿�Á·Ä½�½Ë÷ÿÊ�Ľ�ý·�ɻȸ¿ÉÏÅ�Ľ�ÊËÂÅĽ�É·�Í¿Á·�ķĽ�ͷ·Ľ�¸·Ï·ºƔ����Ë÷ͷ½�É·�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻƔ�

훊픦���묻펂읊칺푷킪쁢몋푾�펆펂힎풞컪찒큲읊줂욚옪핂푷킲쿦핖킃삖삲��� y ƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ �쩖픊옪헒훊킻킪폲�

ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-866-333-3530 (TTY (հեռատիպ)՝ 711):

ұƔؽҵםؽҹ�җҕҽұƔ�җҕ�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ�ҝөؽ�җҕөҕ�әҵҕӱө�өؽ�ҽӭ�җҵҕ ҕםҝ�ҵҕؽӶҵӭؽ�җӁӥҕҝ�ҷҗҕؽӱ܃�ҝҹұӭؽӶ�өׁ�ؽҵҹם�ؽәҝםҕҵ�җӱ�ҷҗҕӭ�әƓ�ҕםҝӶҥӱ

ȗȢȝȡȕȢȝȚƓ��Țɚɔɑ�ɋɤ�ɌɗɋɗəɑɛɎ�ɖɉ�əɜɚɚɓɗɕ�ɨɐɤɓɎƑ�ɛɗ�ɋɉɕ�ɍɗɚɛɜɘɖɤ�ɊɎɚɘɔɉɛɖɤɎ�ɜɚɔɜɌɑ�ɘɎəɎɋɗɍɉƔ��ȜɋɗɖɑɛɎ�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺɛɎɔɎɛɉɒɘƓ�ʾʸy ƻƔ�

կְֻׁ窃 חג׀鑧ֶꨵծדתʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ�կְֽׅתⵃ欽 ׀鎉铂佄 ך㜥さծ搀俱 ׁ鑧岣䠐✲갪傈劤铂

E

�� �� o�Ɠ��É¿�¾·¸Â·�»ÉÆ·ĠÅÂƑ�Ê¿»Ä»�·�ÉË�º¿ÉÆÅÉ¿¹¿ĤÄ�É»ÈÌ¿¹¿ÅÉ�½È·ÊË¿ÊÅÉ�º»�·É¿ÉʻĹ¿·�¿ĽŎċÉÊ¿¹·Ɣ���·û�·Â�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻƔ� E I

���������Ɠ��¼�ÏÅË�ÉÆ»·Á��Ľ¿ɾƑ�·Ľ˷½»�·ÉÉ¿ÉʷĹ»�É»ÈÌ¿¹»ÉƑ�¼È»»�ż�¹¾·È½»Ƒ�·È»�·Ì·¿Â·¸Â»�ÊÅ�ÏÅËƔ��·ÂÂ�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻƔ�

�

�ÈÅŰ¹¿»Ä¹Ï�ż��·Ä½Ë·½»��ÉÉ¿ÉʷĹ»��»ÈÌ¿¹»É�·È»��Ì·¿Â·¸Â»�ÅËÈÉƓ�ʿ�·ƔÃƔ�ÊÅ�ʿ�ÆƔÃƔƑ�ɻ̻Ä�º·ÏÉ�·�Í»»Á�¼ÈÅÃ��¹ÊŸ»È�ʸ�ʾÈÅ˽¾��·È¹¾�ʺʸ�·Äº��Åĺ·Ï�ÊÅ�È ¿º·Ï�¼ÈÅÃ��ÆÈ¿Â�ʸ�ʾÈÅ˽¾��»Æʻø»È�ʺʷ

» «

»

¯ ¥ ¥ ª ¥ ¯

eं

ˢ ˒ ˯ ˱ ˯ ˒ ˠ ː ˦

˒ ˢ

eं

Discrimination is Against the Law�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�¹ÅÃÆ¿»É�Ϳʾ�·ÆÆ¿¹·¸Â»� »º»È·Â�¹¿Ì¿Â�È¿½¾ÊÉ�·ÍÉ�·Äº�ºÅ»É�ÄÅÊ�º¿É¹È¿Ã¿Ä·Ê»�ÅÄ�ʾ»�¸·É¿É�ż�È·¹»Ƒ�»Ê¾Ä¿¹¿ÊÏƑ�Ä·Ê¿ÅÄ·Â�ÅÈ¿½¿ÄƑ�Ȼ¿½¿ÅÄƑ�½»Äº»ÈƑ�É»ÎƑ�·½»Ƒ�ûÄÊ·Â�ÅÈ�ƾÏÉ¿¹·Â�º¿É·¸¿Â¿ÊÏƑ�¾»·Âʾ�ÉÊ·ÊËÉƑ�È»¹»¿ÆÊ�ż�¾»·Âʾ�¹·È»Ƒ�¹Â·¿ÃÉ�»Îƻȿ»Ä¹»Ƒ�ûº¿¹·Â�¾¿ÉÊÅÈÏƑ�½»Ä»Ê¿¹�¿Ä¼ÅÈ÷ʿÅÄƑ�»Ì¿º»Ä¹»�ż�¿ÄÉËÈ·¸¿Â¿ÊÏƑ�ÅÈ�½»Å½È·Æ¾¿¹�ÂŹ·Ê¿ÅÄƔ��¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�ºÅ»É�ÄÅÊ�»Î¹Â˺»�Æ»ÅÆ»�ÅÈ�ÊÈ»·Ê�ʾ»Ã�º¿Ů»È»ÄÊÂÏ�¸»¹·ËÉ»�ż�ż�È·¹»Ƒ�»Ê¾Ä¿¹¿ÊÏƑ�Ä·Ê¿ÅÄ·Â�ÅÈ¿½¿ÄƑ�Ȼ¿½¿ÅÄƑ�½»Äº»ÈƑ�É»ÎƑ�·½»Ƒ�ûÄÊ·Â�ÅÈ�ƾÏÉ¿¹·Â�º¿É·¸¿Â¿ÊÏƑ�¾»·Âʾ�ÉÊ·ÊËÉƑ�È»¹»¿ÆÊ�ż�¾»·Âʾ�¹·È»Ƒ�¹Â·¿ÃÉ�»Îƻȿ»Ä¹»Ƒ�ûº¿¹·Â�¾¿ÉÊÅÈÏƑ�½»Ä»Ê¿¹�¿Ä¼ÅÈ÷ʿÅÄƑ�»Ì¿º»Ä¹»�ż�¿ÄÉËÈ·¸¿Â¿ÊÏƑ�ÅÈ�½»Å½È·Æ¾¿¹�ÂŹ·Ê¿ÅÄƔ�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·ƓƷ� �ÈÅÌ¿º»É�¼È»»�·¿ºÉ�·Äº�É»ÈÌ¿¹»É�ÊÅ�Æ»ÅÆ»�Ϳʾ�º¿É·¸¿Â¿Ê¿»É�ÊÅ�¹ÅÃÃËÄ¿¹·Ê»�»Ů»¹Ê¿Ì»ÂÏ�Ϳʾ�ËÉƑ�É˹¾�·ÉƓ

�ܞ �È¿ÊÊ»Ä�¿Ä¼ÅÈ÷ʿÅÄ�¿Ä�Åʾ»È�¼ÅÈ÷ÊÉ�ƺ·Ƚ»�ÆÈ¿ÄÊƑ�·Ëº¿ÅƑ�·¹¹»ÉÉ¿¸Â»�»Â»¹ÊÈÅÄ¿¹�¼ÅÈ÷ÊÉƑ�Åʾ»È�¼ÅÈ÷ÊÉƻ Ʒ� �ÈÅÌ¿º»É�¼È»»�·Ľ˷½»�É»ÈÌ¿¹»É�ÊÅ�Æ»ÅÆ»�;ÅÉ»�Æȿ÷ÈÏ�·Ľ˷½»�¿É�ÄÅÊ��Ľ¿ɾƑ�É˹¾�·ÉƓ

�ܞ �Ë·Â¿Ű»º�¿ÄÊ»ÈÆȻʻÈÉ �ܞ �ļÅÈ÷ʿÅÄ�ÍÈ¿ÊÊ»Ä�¿Ä�Åʾ»È�·Ľ˷½»É

�¼�ÏÅË�Ä»»º�ʾ»É»�É»ÈÌ¿¹»ÉƑ�¹ÅÄÊ·¹Ê��¿Ê·Â¿ÊÏ��»Ã¸»È��»ÈÌ¿¹»��»Æ·ÈÊûÄÊ�·Ê�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ�ÊÅ�¾»ÂÆ�ÏÅËƔ��ÅËÈÉ�·È»�ʿ�·ƔÃƔ�ÊÅ�ʿ�ÆƔÃƔƑ�ɻ̻Ä�º·ÏÉ�·�Í»»Á�¼ÈÅÃ��¹ÊŸ»È�ʸ�ʾÈÅ˽¾��·È¹¾�ʺʸ�·Äº��Åĺ·Ï�ÊÅ� È¿º·Ï�¼ÈÅÃ��ÆÈ¿Â�ʸ�ʾÈÅ˽¾��»Æʻø»È�ʺʷƔ��ÅË�¹·Ä�·ÂÉÅ�·ÉÁ�¼ÅÈ�·��¿Ì¿Â��¿½¾ÊÉ��ÅÅȺ¿Ä·ÊÅÈ�;Å�ÍÅÈÁÉ�¼ÅÈ��¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·Ɣ�¼�ÏÅË�¸»Â¿»Ì»�ʾ·Ê��¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�¾·É�¼·¿Â»º�ÊÅ�ÆÈÅÌ¿º»�ʾ»É»�É»ÈÌ¿¹»É�ÅÈ�º¿É¹È¿Ã¿Ä·Ê»º�¿Ä�·ÄÅʾ»È�Í·Ï�ÅÄ�ʾ»�¸·É¿É�ż�È·¹»Ƒ�¹ÅÂÅÈƑ�Ä·Ê¿ÅÄ·Â�ÅÈ¿½¿ÄƑ�·½»Ƒ�º¿É·¸¿Â¿ÊÏƑ�ÅÈ�É»ÎƑ�ÏÅË�¹·Ä�Ű»�·�½È¿»Ì·Ä¹»�ͿʾƓ�

�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�������»Ã¸»È��»ÈÌ¿¹»É��»Æ·ÈÊûÄÊ�ƺ�ÅÃÆ·¿ÄÊÉƻʸʿʷʷʷ��Ê˺»¸·Á»È��Å·ºƑ��Ë¿Ê»�ˀʽʷ�»ÈÈ¿ÊÅÉƑ����ˀʷʾʷʺ���ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ���Ɠ�ʾʸy ƻ���� ��Ɠ�ʸƖʿʽʽƖʹʷ Ɩʾʽʼʺˀ� �ÅË�¹·Ä�Ű»�·�½È¿»Ì·Ä¹»�¿Ä�Æ»ÈÉÅÄ�ÅÈ�¸Ï�÷¿ÂƑ�¼·ÎƑ�ÅÈ�»Ã·¿ÂƔ��¼�ÏÅË�Ä»»º�¾»ÂÆ�Ű¿Ľ�·�½È¿»Ì·Ä¹»Ƒ�·��¿Ê·Â¿ÊÏ��¿Ì¿Â��¿½¾ÊÉ��ÅÅȺ¿Ä·ÊÅÈ�¿É�·Ì·¿Â·¸Â»�ÊÅ�¾»ÂÆ�ÏÅËƔ� �ÅË�¹·Ä�·ÂÉÅ�Ű»�·�¹¿Ì¿Â�È¿½¾ÊÉ�¹ÅÃÆ·¿ÄÊ�Ϳʾ�ʾ»��Ɣ�Ɣ��»Æ·ÈÊûÄÊ�ż��»·Âʾ�·Äº��Ë÷Ä��»ÈÌ¿¹»ÉƑ��ů¹»�¼ÅÈ��¿Ì¿Â��¿½¾ÊÉƑ�»Â»¹ÊÈÅÄ¿¹·ÂÂÏ�ʾÈÅ˽¾�ʾ»��ů¹»�¼ÅÈ��¿Ì¿Â��¿½¾ÊÉ��ÅÃÆ·¿ÄÊ��ÅÈÊ·ÂƑ�·Ì·¿Â·¸Â»�·Ê�¾ÊÊÆÉƓƭƭŹÈÆÅÈÊ·ÂƔ¾¾ÉƔ½ÅÌƭŹÈƭÆÅÈÊ·ÂƭŸ¸ÏƔÀɼƑ�ÅÈ�¸Ï�÷¿Â�ÅÈ�ƾÅÄ»�·ÊƓ �Ɣ�Ɣ��»Æ·ÈÊûÄÊ�ż��»·Âʾ�·Äº��Ë÷Ä��»ÈÌ¿¹»Éʹʷʷ��ĺ»Æ»Äº»Ä¹»��Ì»ÄË»Ƒ��� �ÅÅÃ�ʼʷˀF Ƒ������˿º¿Ä½�·É¾¿Ä½ÊÅÄƑ��Ɣ�Ɣ�ʹʷʹʷʸ�ʸƖʿʷʷƖʺʽʿƖy ʷʸˀƑ�ʿʷʷƖʼʺ Ɩʾʾ ʽˀʾ�ƺ���ƻ �ÅÃÆ·¿ÄÊ�¼ÅÈÃÉ�·È»�·Ì·¿Â·¸Â»�·Ê�¾ÊÊÆƓƭƭÍÍÍƔ¾¾ÉƔ½ÅÌƭŹÈƭÅů¹»ƭŰ»ƭ¿Äº»ÎƔ¾ÊÃÂƔ�

ܞ �Ë·Â¿Ű»º�É¿½Ä�·Ľ˷½»�¿ÄÊ»ÈÆȻʻÈÉ

�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�¹ËÃÆ»�¹ÅÄ�·É�»ϻÉ�¼»º»È·Â»É�º»�º»È»¹¾ÅÉ�¹¿Ì¿Â»É�·Æ¿¹·¸Â»É�Ï�ÄÅ�º¿É¹È¿Ã¿Ä·�ÆÅÈ�ÃÅÊ¿ÌÅÉ�º»�ȷзƑ�¹ÅÂÅÈƑ�Ä·¹¿Åķ¿º·ºƑ»º·ºƑ�º¿É¹·Æ·¹¿º·º�Å�É»ÎÅƔ��

�

�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·� 㸚點欽涸耠齦孖奘岀䖒鋉㹀♶㔓珏做ծ芔葿ծ孖做過窟ծ䎃룰ծ婩ꥺ䧴䚍ⴽ罜威⟣⡦➂կ���

�¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�¿É�·Ä�����Ϳʾ�·��»º¿¹·È»�¹ÅÄÊÈ·¹ÊƔ���ÄÈÅÂÂûÄÊ�¿Ä��¿Ê·Â¿ÊÏ��»·Âʾ��·Ä�ż��·Â¿¼ÅÈÄ¿·�º»Æ»ÄºÉ�ÅÄ�¹ÅÄÊÈ·¹Ê�ȻĻͷÂƔ �¾¿É�¿Ä¼ÅÈ÷ʿÅÄ�¿É�ÄÅÊ�·�¹ÅÃÆ»ʻ�º»É¹È¿ÆÊ¿ÅÄ�ż�¸»Ä»ŰÊÉƔ���·ÂÂ�ʸƖʿʽʽƖʺʺʺƖʺʼʺʷ�ƺ����ʾʸy ƻ�¼ÅÈ�ÃÅÈ»�¿Ä¼ÅÈ÷ʿÅÄ�ʿ�·ƔÃƔ�ÊÅ�ʿ�ÆƔÃƔƑ�ɻ̻Ä�º·ÏÉ�·�Í»»Á� ¼ÈÅÃ��¹ÊŸ»È�ʸ�ʾÈÅ˽¾��·È¹¾�ʺ Ƒy�·Äº�ʿ�·ƔÃƔ�ÊÅ�ʿ�ÆƔÃƔ��Åĺ·Ï�ÊÅ� È¿º·Ï�¼ÈÅÃ��ÆÈ¿Â�ʸ�ʾÈÅ˽¾��»Æʻø»È�ʺʷƔ

BENEFIT HIGHLIGHTS 2019

Medicare Advantage HMO with Prescription Drugs

Vitality Health Plan of California 18000 Studebaker Road, Suite 960 Cerritos, CA 90703

For enrollment inquiries, or to speak to a Member Services representative, please call 1-866-333-3530 or TTY 711 8 a.m. to 8 p.m. seven days a week from October 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday from April 1 through September 30

www.VitalityHP.net

http:www.VitalityHP.net

2019 BENEFIT HIGHLIGHTS