Florida

Gold Dialysis & Kidney / Diálisis y Riñon de Oro

(H1526-009)

For those who are Medicare-eligible and have end-stage renal disease (ESRD), generally requiring dialysis

Counties: Gila, Maricopa, Pima, Pinal

Counties: Miami-Dade

$0

Copay for PCPs and most specialists

$0

Copay for Dialysis

$0

Rx deductible and Insulin (Tier 6) copay

$2,500 Flex allowance per year

This allowance is distributed quarterly, with rollover, for dental, vision, and hearing expenses

4G Smartphone*

This benefit is supplied through Gold Kidney’s mobile phone and services partner and includes unlimited talk, text, and data

$1,200 Gold Perks Plus allowance per year

This benefit package is distributed monthly, without rollover, for the purchase of plan-defined product and service categories

$1,200 healthy food allowance* per year

This allowance is distributed monthly, without rollover, for healthy food, produce, and prepared meals

72 one-way trips to medical appointments per year

This benefit is for non-emergency transportation to health-related locations

$1,200 fuel & rideshare allowance* per year

This allowance is distributed monthly, without rollover, for fuel and rideshare expenses

Pre- and post-kidney transplant assistance

This benefit provides additional dental benefits and caretaker assistance for pre- and post-kidney transplant

In-home support and companionship

This benefit provides up to 60 hours per year of in-home support for activities such as light household chores

Personal emergency response device

This benefit provides one wearable PERS device per year to connect members to urgent support resources

Rx Benefits

Rx deductible

$0

This is what you will pay before Gold Kidney starts paying for covered prescription medications

30-day Rx copay
(Tiers 1-6)

$0 / $5 / $47 / $100 / 33% / $0

This is what you will pay for prescription medications

100-day mail order Rx
(Tiers 1–6)

$0 / $5 / $40 / $250 / NA / $0

This is what you will pay for a long-term supply of prescription medications through a convenient mail-order service

Gold Perks Plus

$1,200 Annual Allowance

Utility bills*
Pest control services*
Over-the-counter items (OTC)
Indoor air quality equipment and Services*
Therapeutic massage
Personal care services*
Fitness activity fees
Home and bathroom safety devices
Pet supplies and services*

Additional Benefits**

**Refer to the Summary of Benefits for specific benefits and coverage amounts

$2,500 annual Flex allowance for dental, vision, and hearing, with quarterly rollover

4G smartphone with unlimited talk, text, and data*

$1,200 annual allowance for healthy food, and produce*

2 prepared meals per day, for 14 days, up to 4 times per year following surgery or an in-patient hospitalization

72 one-way trips per year for non-emergency transportation to health-related locations

$1,200 annual allowance for fuel and rideshare services*

Up to $300 annually in Rewards & Incentives for preventive health activities

Silver&Fit gym membership with a comprehensive fitness and well-being program

60 hours of in-home companionship and support annually

Wearable personal emergency response device equipped with GPS and fall-detection

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¹If you receive Medicaid/AHCCS benefits, your premium and coinsurance will be paid by these programs.

*Requires one of the CMS-listed chronic illnesses, SSBCI program requirements, and participation in the Gold Kidney’s care management program for C-SNP plan members. Learn more about SSBCI here

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