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VIVA MEDICARE Plus
Agent Access

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Member Services
1-800-633-1542
New Members
1-888-830-8482
TTY Users
1-800-548-2546

Regular Call Center Hours
Monday - Friday from
8 a.m. - 8 p.m. CST
Extended Call
Center Hours
Until
February 14, 2012
Monday - Sunday from
8 a.m. - 8 p.m. CST

Copayment Chart

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2012 Copayment Chart

VIVA MEDICARE Plus Rx1 VIVA MEDICARE Plus Rx Premier1 VIVA MEDICARE Plus Select1 VIVA MEDICARE Plus Rx Extra Value3
FullMedIcAId, QMB, SlMB+ QdWI, QII, SlMB only
Monthly Premium1 $0 $99 $0 $0 $0
Hospital Stay $235/day for days 1-6: $0/day for days 7-90 $175/day for days 1-6: $0/day for days 7-90 $150/day for days 1-6: $0/day for days 7-90 $0/day Pays 1-6 $125/day. $0 for additional days.
PCP $20 $10 $15 $0 $0
Specialist $40 $30 $30 $0 $10
Outpatient Surgery $350 $225 $250 $0 $75
Emergency Room $65 $65 $65 $0 $65
Ambulance $200 per
one-way trip		 $150 per
one-way trip		 $150 per
one-way trip		 $0 per
one-way trip		 $50
Skilled Nursing Facillity $50 copay per day 1-100 $50 copay per day 1-30, $0 per day 31-100 $50 copay per day 1-50, $0 per day 51-100 $0 $30 copay per day 1-30, $0 per day 31-100
Durable Medical Equipment/ Prosthetics 20% 20% 20% 0% 10%