| Benefits* | Description | In-Network Costs |
|---|---|---|
Doctor visits |
No copays for visits to your primary care provider (PCP), and low copays for endocrinologists, and cardiologists | $0 co-pay for PCPs, $10 co-pay for endocrinologists and cardiologists |
Immunizations |
Vaccines for COVID-19, Pneumonia, Influenza and Hepatitis B | $0 cost to member |
Preventive
|
Many preventive services are covered, including annual wellness visit, breast cancer screening, colorectal cancer screening, diabetes screening | $0 cost to member |
Help with diabetes insulin and supplies |
Reduced cost sharing across a number of services, including reduced copays for all forms of insulin, diabetes supplies and services, and diabetic shoes |
Lesser value of 25% or $35
co-pay for a one-month
supply of select insulins $0 co-pay for diabetic supplies and services 20% coinsurance for diabetic shoes and inserts |
Dental services |
Preventive & comprehensive dental services include oral exams, dentures, X-rays, extractions, fillings and deep cleanings |
$0 cost to member
$2,000 benefit annually |
Vision services |
Routine vision screening, lenses, frames, and/or contacts |
$0 cost to member
$250 benefit annually |
Transportation |
36 one-way, non-emergent, plan-approved, health-related location transportations are included | $0 cost to member |
Hearing services |
Routine hearing exams, hearing aids, and hearing aid services (including evaluation and fitting, repair, and batteries) |
$0 cost to member
$2,500 benefit annually |
No copays for visits to your primary care provider (PCP), and low copays for endocrinologists, and cardiologists
$0 co-pay for PCPs, $10 co-pay for endocrinologists and cardiologists
Vaccines for COVID-19, Pneumonia, Influenza and Hepatitis B
$0 cost to member
Many preventive services are covered, including annual wellness visit, breast cancer screening, colorectal cancer screening, diabetes screening
$0 cost to member
Reduced cost sharing across a number of services, including reduced copays for all forms of insulin, diabetes supplies and services, and diabetic shoes
Lesser value of 25% or $35
co-pay for a one-month
supply of select insulins
$0 co-pay for diabetic supplies
and services
20% coinsurance for diabetic
shoes and inserts
Preventive & comprehensive dental services include oral exams, dentures, X-rays, extractions, fillings and deep cleanings
$0 cost to member
$2,000 benefit annually
Routine vision screening, lenses, frames, and/or contacts
$0 cost to member
$250 benefit annually
36 one-way, non-emergent, plan-approved, health-related location transportations are included
$0 cost to member
Routine hearing exams, hearing aids, and hearing aid services (including evaluation and fitting, repair, and batteries)
$0 cost to member
$2,500 benefit annually
| Benefits* | Description | In-Network Costs |
|---|---|---|
Transportation |
36 one-way, non-emergent plan approved health-related location transportations are included | $0 cost to member |
Immunizations |
Vaccines for COVID-19, pneumonia, influenza, and Hepatitis B | $0 cost to member |
Preventive services |
Many preventive services are covered, including an annual wellness visit, breast cancer screening, colorectal cancer screening, diabetes screening | $0 cost to member |
Dental services |
Preventive and comprehensive dental services include oral exams, dentures, x-rays, extractions, fillings, and deep cleanings |
$0 cost to member
$2,500 benefit annually |
Vision services |
Routine vision screening, lenses, frames, and/or contacts |
$0 cost to member
$300 benefit annually |
Comfort Care Catalog |
Healthcare dollars to spend on over-the-counter products and benefits |
$0 cost to member
Benefit varies by state |
Hearing services |
Routine hearing exams, hearing aids, and hearing aid services (including evaluation and fitting, repair, and batteries) |
$0 cost to member
$2,000 benefit annually |
36 one-way, non-emergent plan approved health-related location transportations are included
$0 cost to member
Vaccines for COVID-19, pneumonia, influenza, and Hepatitis B
$0 cost to member
Many preventive services are covered, including an annual wellness visit, breast cancer screening, colorectal cancer screening, diabetes screening
$0 cost to member
Preventive and comprehensive dental services include oral exams, dentures, x-rays, extractions, fillings, and deep cleanings
$0 cost to member
$2,500 benefit annually
Routine vision screening, lenses, frames, and/or contacts
$0 cost to member
$300 benefit annually
Healthcare dollars to spend on over-the-counter products and benefits
$0 cost to member
Benefit varies by state
Routine hearing exams, hearing aids, and hearing aid services (including evaluation and fitting, repair, and batteries)
$0 cost to member
$2,000 benefit annually