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2021 Plans

ELITE

Sep 29, 2020, 10:20 AM
Title : ELITE
Primary Care Visit Copay : $0
Specialist Visit Copay : $25
Dental Benefit : $700 reimbursement limit
Includes Rx : No
Preventive Services : Yes
Prescription Drug Coverage : No
Over-the-Counter Benefit Card : Yes
Meal Delivery (Delivery of 20 meals after hospital stay. Limited 4 times/calendar year.) : Yes
Telehealth / Virtual Visits Copay : No
Travel Benefit : Yes
Fitness Benefit : Yes
Sort : 5
$30
$3,450
$30/visit
$90/visit
$5
$325/stay
$150 per surgery

Days 1-20: $0

Days 21-100: $150/day

$48.10/month
Initial routine eye exam each year:
$0 copay
Plan pays $100 per year
for frames, lenses, and contacts
Annual hearing exam: $25
Hearing aids: $700-$1,050 per aid
Limit: 1 per ear, per year
12 (60-minute) visits per year: $0

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Looking for pharmacy benefits information? Check out our drug coverage page.

2 Includes annual check and Medicare-approved vaccines, screenings, and tests

4 See the chart

5 Get reimbursed for dental services from a dentist you choose. Reimbursement limits: Core D=$300/Value D=$500/Elite D=$700/Value = $500/Elite=$700

7 Covers $50 OTC health-related items per quarter

8 20 meals delivered after a covered facility stay. Limited 4 times/year

10 $25/month reimbursement for an licensed facility

This webpage was updated on October 19, 2020.