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Pruitt Health Premier

North Carolina

Coordinated Care & More Personal Attention

PruittHealth Premier (HMO I-SNP) is an HMO I-SNP contracted with Medicare. PruittHealth Premier offers an Institutional Special Needs Plan (I-SNP). The PruittHealth Premier Institutional Special Needs Plan (I-SNP) offers a health plan specially designed for eligible Medicare beneficiaries living in our participating long-term care nursing centers.

As a Member of PruittHealth Premier you receive not only the standard benefits offered by original Medicare, but the added attention and care so important to your health and well-being.

PruittHealth Premier covers all medically-necessary and preventive services covered under Medicare Part A and Part B, and prescription drug coverage under Part D. Plus, we cover extra benefits including vision, hearing, routine foot care, preventive care, and transportation.

Membership advantages include:

  • Part D prescription drug coverage.
  • Routine vision, hearing, foot care, and preventive services and screenings.
  • Coordinated care and more personal attention.
  • Dedicated nurse practitioner as your trusted partner to manage your care and collaborate with your doctors, your family, and the nursing center staff.
  • Regular face to face visits from your nurse practitioner to help you avoid unnecessary and often unwanted trips to the hospital.
  • Nurse practitioners can complete tests and treatments in the nursing center that are normally done in the hospital.
  • One point of contact for communication with you, your family, your doctors, and the nursing center staff.
  • Friendly, responsive customer service.

Benefit Highlights

How much is the monthly premium?
$26.40 per month. In addition, you must keep paying your Medicare Part B premium.

How much is the deductible?
$185 per year for in-network services.
$435 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly limit(s) in this plan:

  • $6,600 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

 Benefits Coverage
Primary Care Physician (PCP) Visit $0 Copay 
Podiatry $0 Copay for 6 routine foot care visits per year
Hearing $0 Copay for routine hearing exam, hearing aid fitting and up to $1,250 for hearing aids every two year for hearing aids
Vision $0 Copay – for routine eye exam and a $225 allowance every year for eyewear
Preventive Care $0 Copay for in-room and office visits
Skilled Nursing $0 Copay – no prior hospital stay required
Non-emergency Transportation $0 Copay for 24 one-way trips for non-emergency health services
OTC (Over-the-Counter) Items Monthly allowance for certain OTC items

Full benefits, plan premiums, and cost sharing information for this plan may be found within the Summary of Benefits.

PruittHealth Premier Management

PruittHealth Premier is locally-managed by PruittHealth, Inc. (PruittHealth).

Since its inception in 1969, the PruittHealth community of services has grown into one of the largest and most well-respected skilled nursing providers in the state of Georgia; operating some of the highest-performing post-acute and long-term care facilities in Georgia.

PruittHealth and its affiliated entities have since expanded into South Carolina, North Carolina, and Florida and encompass more than 90 post-acute, skilled nursing, assisted and independent living facility affiliates.

Want more information about PruittHealth Premier?

Call us at 844-224-3659 TTY 711.
Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact request form to have us call you.

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