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INTEGRIS Health Partners+ Premier

Medical and Medicare Part D (Outpatient Prescription Drug) Benefits

Plan Premium Medical Maximum out of pocketAdditional Benefits (these are benefits not covered by Medicare)
$30
You must continue to pay your Medicare Part B premium
$4,700

Common Medical benefits and your copays - remember that if you reach your Medical Maximum Out of Pocket limit, the rest of your Medicare-covered medical services are paid by CommunityCare

Doctors Visits provider search$0 for Primary Care
$35 for Specialist
Emergency & Urgent Care – Worldwide coverage$90 for Emergency Room - waived if admitted
$0 - $35 copay for Urgent Care
Outpatient Hospital$250 copay
Outpatient Rehab (such as Physical Therapy)$20 copay per visit
Outpatient Diagnostic Services$0 - $100 copay, depending on the service
Inpatient Hospital$245 copay per day for days 1-5

This plan includes Part D (outpatient prescription drug coverage) - your copay will depend on what Tier level your prescription is. Copays can change if you move out of the Initial Coverage level.

Initial Coverage Level Copays formulary search30-day Supply
Tier 1 - Preferred Generic$5 copay
Tier 2 - Generic$12 copay
Insulin Tier$35 copay for covered insulin
Tier 3 - Preferred Brand Name$40 copay - * $100 deductible applies
Tier 4 - non-Preferred Drugs$95 copay - * $100 deductible applies
Tier 5 - Specialty Tier31% of the cost - * $100 deductible applies

For 2022, this plan participates in the Part D Senior Savings Model which offers lower, stable and creditable out of pocket costs for covered insulin through the different Part D benefit coverage stages. You will pay a maximum of $35 for a 1-month supply of covered insulin during the Initial Coverage and Coverage Gap (or Donut Hole) stages of your benefit.

We also have mail order through CVS or Walgreens where you can purchase a 90-day supply of available drugs for a reduced cost. Mail order information.

You can call our Medicare team at 405-810-2012, TTY/TDD (800)722-0353, for more information on this plan or other options. We are available Monday through Friday from 8:00 to 6:00.

Directories and Searches

Enrollment Options

If you are not sure which plan best suits you, give us a call at 405-810-2012. One of our representatives will help you select the right plan for you. Or you can join us at one of our seminars where we go through your plan options. Our Sales team is available by phone 8:00 to 6:00 Monday through Friday.

Plan Documents

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