Erickson Advantage Signature with Drugs (HMO-POS) Benefits

Erickson Advantage | HMO
Plan website: www.EricksonAdvantage.com
Plan Phone Number: (800) 989-1389
U.S. News Preferred Broker Phone: (888) 245-3931

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Inpatient Care

Hospital Care

No limit to the number of days covered by the plan each hospital stay.

$0 copay for each additional non-Medicare-covered hospital day.

Outpatient Care

Doctor Office Visits

$0 copay for each Medicare-covered primary care doctor visit.

$35 copay for each Medicare-covered specialist visit.

Doctor and Hospital Choice

No referral required for network doctors specialists and hospitals.

Diagnostic Tests, X-Rays, Lab Services and Radiology Services

$0 copay for Medicare-covered lab services

$0 copay for Medicare-covered diagnostic procedures and tests

$20 copay for Medicare-covered X-rays

$50 copay for Medicare-covered diagnostic radiology services (not including X-rays)

$30 copay for Medicare-covered therapeutic radiology services

If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $0 to $35 may apply

If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $0 to $35 may apply

Emergency Care

$50 copay for Medicare-covered emergency room visits

Worldwide coverage.

If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit.

Durable Medical Equipment

20% of the cost for Medicare-covered durable medical equipment

Diabetes Programs and Supplies

$0 copay for Medicare-covered Diabetes self-management training

20% of the cost for Medicare-covered Diabetes monitoring supplies

20% of the cost for Medicare-covered Therapeutic shoes or inserts

Ambulance Services

$150 copay for Medicare-covered ambulance benefits.

Urgently Needed Care

$30 copay for Medicare-covered urgently-needed-care visits

Outpatient Services

$50 copay for each Medicare-covered ambulatory surgical center visit

$0 to $50 copay for each Medicare-covered outpatient hospital facility visit

Chiropractic Services

$20 copay for each Medicare-covered chiropractic visit

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).

Outpatient Mental Health Care

$0 to $30 copay for each Medicare-covered individual therapy visit

$0 copay for each Medicare-covered group therapy visit

$30 copay for each Medicare-covered individual therapy visit with a psychiatrist

$30 copay for each Medicare-covered group therapy visit with a psychiatrist

$30 copay for Medicare-covered partial hospitalization program services

Podiatry Services

$0 copay for each Medicare-covered podiatry visit

$0 copay for up to 6 supplemental routine podiatry visit(s) every year

Medicare-covered podiatry visits are for medically necessary foot care.

Substance Abuse Care

$30 copay for Medicare-covered individual substance abuse outpatient treatment visits

$30 copay for Medicare-covered group substance abuse outpatient treatment visits

Outpatient Rehabilitation Services

Medically necessary physical therapy occupational therapy and speech and language pathology services are covered.

$0 copay for Medicare-covered Occupational Therapy visits

$0 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

Prosthetic Devices

20% of the cost for Medicare-covered prosthetic devices

20% of the cost for Medicare-covered medical supplies related to prosthetics splints and other devices

Preventive Services

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

$0 copay for a supplemental annual physical exam

Cardiac and Pulmonary Rehabilitation Services

$0 copay for Medicare-covered Cardiac Rehabilitation Services

$0 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$0 copay for Medicare-covered Pulmonary Rehabilitation Services

Kidney Disease and Conditions

20% of the cost for Medicare-covered renal dialysis

$0 copay for Medicare-covered kidney disease education services

Additional Benefits

Dental Services

$35 copay for Medicare-covered dental benefits

$35 copay for a supplemental visit that includes:

up to 1 oral exam(s) every six months

up to 1 cleaning(s) every six months

up to 1 dental x-ray(s) every year

Plan offers additional supplemental comprehensive dental benefits.

$0 copay for up to 1 supplemental oral exam(s) every six months

$0 copay for up to 1 supplemental cleaning(s) every six months

$0 copay for up to 1 supplemental fluoride treatment(s) every six months

$0 copay for up to 1 supplemental dental x-ray(s)

$1 000 plan coverage limit for supplemental dental benefits every year

Hearing Services

Hearing aids not covered.

$35 copay for Medicare-covered diagnostic hearing exams

$35 copay for up to 1 supplemental routine hearing exam(s) every year

Vision Services

$0 to $35 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye including an annual glaucoma screening for people at risk

$35 copay for up to 1 supplemental routine eye exam(s) every year

$0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.

$0 copay for up to 1 pair(s) of eyeglasses (lenses and frames) every two years

$0 copay for contact lenses

$100 plan coverage limit for supplemental eyewear every two years

Over-the-Counter Items

The plan does not cover Over-the-Counter items.

Mental Health Care

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

$0 copay

Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

Skilled Nursing Facility (SNF)

Plan covers up to 100 days each benefit period

No prior hospital stay is required.

For Medicare-covered SNF stays:

Days 1 - 20: $0 copay per day

Days 21 - 87: $75 copay per day

Days 88 - 100: $0 copay per day

Home Health Care

$0 copay for each Medicare-covered home health visit

Hospice

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.

Transportation

$0 copay for up to 24 one-way trip(s) to plan approved location every year

Acupuncture

This plan does not cover Acupuncture and other alternative therapies.

Wellness/Education & Other Benefits

This plan does not cover supplemental education/wellness programs.

$0 copay for Falls Prevention Program. Contact plan for details.

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