| — Plan Health Benefits — |
| ** Base Program ** |
| Premium |
| • Total monthly premium: $57.50 |
| • Health plan premium: $1 |
| • Drug plan premium: $56.50 |
| • Y'all must go on to pay your Role B premium. |
| • Part B premium reduction: No |
| Deductible |
| • Health plan deductible: $0 |
| • Other health plan deductibles: In-network: No |
| • Drug plan deductible: No almanac deductible |
| Maximum out-of-pocket enrollee responsibleness (does not include prescription drugs) |
| • $4 |
| Optional supplemental benefits |
| • No |
| Boosted benefits and/or reduced cost-sharing for enrollees with certain health weather condition? |
| • In-network: Aye |
| Physician visits |
| • Main: $0 copay |
| • Specialist: $40 copay per visit |
| Diagnostic procedures/lab services/imaging |
| • Diagnostic tests and procedures: $0 copay (authorisation required) |
| • Lab services: $0 copay (say-so required) |
| • Diagnostic radiology services (e.g., MRI): $0-200 copay (potency required) |
| • Outpatient x-rays: $xl copay (potency required) |
| Emergency intendance/Urgent intendance |
| • Emergency: $xc copay per visit (always covered) |
| • Urgent care: $15-twoscore copay per visit (always covered) |
| Inpatient hospital coverage |
• $250 per solar day for days i through 6
$0 per twenty-four hours for days 7 through ninety (authorization required) |
| Outpatient hospital coverage |
| • $350 copay per visit (authorisation required) |
| Skilled Nursing Facility |
• $0 per mean solar day for days 1 through 20
$188 per day for days 21 through 100 (authority required) |
| Preventive care |
| • $0 copay (authorization required) |
| Ground ambulance |
| • $250 copay |
| Rehabilitation services |
| • Occupational therapy visit: $20 copay (potency required) |
| • Physical therapy and spoken communication and language therapy visit: $20 copay (authorisation required) |
| Mental wellness services |
• Inpatient hospital - psychiatric: $250 per solar day for days one through half-dozen
$0 per mean solar day for days 7 through ninety (potency required) |
| • Outpatient group therapy visit with a psychiatrist: $xl copay |
| • Outpatient individual therapy visit with a psychiatrist: $40 copay |
| • Outpatient group therapy visit: $forty copay (authorization required) |
| • Outpatient individual therapy visit: $40 copay (authorization required) |
| Opioid treatment program services |
| • In-network: $5.00 copay |
| Medical equipment/supplies |
| • Durable medical equipment (east.thou., wheelchairs, oxygen): 20% coinsurance per item (authorization required) |
| • Prosthetics (e.grand., braces, artificial limbs): 20% coinsurance per item (authorisation required) |
| • Diabetes supplies: 0-twenty% coinsurance per item (authorization required) |
| Dialysis |
| • 20% coinsurance |
| Hearing |
| • Hearing exam: $40 copay |
| • Fitting/evaluation: $0 copay |
| • Hearing aids: $499-799 copay (limits apply) |
| Preventive dental |
| • Oral exam: $0 copay (limits utilize) |
| • Cleaning: $0 copay (limits apply) |
| • Fluoride treatment: Not covered |
| • Dental x-ray(due south): $0 copay (limits apply) |
| Comprehensive dental |
| • Non-routine services: Non covered |
| • Diagnostic services: Not covered |
| • Restorative services: 20% coinsurance (limits utilise) |
| • Endodontics: 20% coinsurance (limits apply) |
| • Periodontics: 20% coinsurance (limits apply) |
| • Extractions: 20% coinsurance (limits employ) |
| • Prosthodontics, other oral/maxillofacial surgery, other services: twoscore% coinsurance (limits apply) |
| Vision |
| • Routine eye exam: $0 copay (limits apply) |
| • Other: Not covered |
| • Contact lenses: $0 copay (limits utilize) |
| • Eyeglasses (frames and lenses): $0 copay (limits utilise) |
| • Eyeglass frames: Not covered |
| • Eyeglass lenses: Non covered |
| • Upgrades: Not covered |
| Medically-canonical non-opioid pain management services |
| • Chiropractic services: Not covered |
| • Acupuncture: Some coverage |
| • Therapeutic Massage: Not covered |
| • Alternative Therapies: Not covered |
| More benefits |
| • Over-the-counter drug benefits: Some coverage |
| • Meals for short elapsing: Non covered |
| • Annual concrete exams: Some coverage |
| • Telehealth: Non covered |
| • WorldWide emergency coverage: Some coverage |
| • WorldWide emergency urgent care: Some coverage |
| • Fettle Do good: Some coverage |
| • In-Abode Back up Services: Not covered |
| • Bathroom Safety Devices: Not covered |
| • Health Education: Some coverage |
| • In-Dwelling Condom Assessment: Not covered |
| • Personal Emergency Response System (PERS): Non covered |
| • Medical Nutrition Therapy (MNT): Some coverage |
| • Mail service belch In-Home Medication Reconciliation: Non covered |
| • Re-admission Prevention: Not covered |
| • Wigs for Hair Loss Related to Chemotherapy: Not covered |
| • Weight Management Programs: Not covered |
| • Adult Day Wellness Services: Non covered |
| • Nutritional/Dietary Benefit: Not covered |
| • Dwelling house-Based Palliative Care: Some coverage |
| • Back up for Caregivers of Enrollees: Not covered |
| • Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered |
| • Enhanced Illness Management: Some coverage |
| • Telemonitoring Services: Not covered |
| • Remote Admission Technologies (including Web/Telephone-based technologies and Nursing Hotline): Some coverage |
| • Counseling Services: Not covered |
| Wellness programs (eastward.one thousand., fitness, nursing hotline) |
| • Covered |
| Transportation |
| • Not covered |
| Pes care (podiatry services) |
| • Pes exams and treatment: $20 copay |
| • Routine foot care: $20 copay (limits apply) |
| Medicare Part B drugs |
| • Chemotherapy: 20% coinsurance (authorisation required) |
| • Other Part B drugs: 20% coinsurance (potency required) |
0 Response to "Keystone 65 Advantage Do I Have to Enroll Every Year Again?"
Post a Comment