MAPD
2027 plan HMO
SCAN Inclusive (HMO)
Plan information effective January 1, 2027.
Plan costs & ratings
Monthly premium$2.00
Medical premium$2.00
Drug premium$0.00
Annual premium$24.00
Medical deductible$0
Drug deductible$250
Max OOP in network$2,500
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in San Francisco County, CASan Francisco County, CA
Available Cities
This plan is available in 1+ cities in California.
Benefits
Primary care
In Network
In-Network: $0 copay per visit
Inpatient hospital
In Network
In-Network: $250 copay per day for days 1-4, $0 copay per day for days 5-90.
Skilled nursing
In Network
In-Network: $0 copay per day for days 1-20, $125 copay per day for days 21-100.
Emergency care
In Network
In-Network: $120 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $175 copay per trip
Plan Overview
CarrierSCAN Health Plan
OrganizationSCAN HEALTH PLAN
Plan typeMAPD
PlanHMO
Drug coverageIncluded
Enrollment hours8 am to 8 pm
Provider searchOpen provider directory
Carrier websiteOpen website
Plan identifiers
Plan IDH5425-149-000
Plan number149
ContractH5425
Segment0
DRX ID1BJ3J3CWYT
Carrier ID15
Formulary ID27384
Formulary versionV11 Last Updated 09-01-2026
Carrier contact
Carrier phone8778704867
Enrollment phone8778704867
Enrollment TTY711
Carrier hours8 am to 8 pm
Network & documents
Preferred pharmacy networkYes
Preferred retail pharmacyYes
Preferred mail pharmacyYes
Mail drug benefitsYes
Provider searchYes