Eyewear - $75 annual allowance High and Core options only. – Eyewear & Hearing Aids $500 every 36 months High & Core Options only. Hearing Aid Benefit - – Primary - $15 copay Primary - $15 copay Primary - $15 Office Visits Specialist - $15 copay Specialist - $30 copay Specialist - $40 100% coverage 100% coverage 10% coinsurance Lab & X-rays Inpatient Hospital 100% after $100 copay per admission 100% after $200 copay per admission $300/day copay for days 1-5; then 100% copay copay copay Outpatient Surgery 100% after a $200 100% after a $250 100% after a $250 Emergency Care (Worldwide) $50 copay per hospital emergency $75 copay per hospital emergency $75 per hospital emergency 100% coverage for days 1 -20 SNF $100 copay per day for days 21 -100 No 3 day inpatient hospital stay required for coverage. per calendar year for Part A and B Services. Out of Pocket Maximum $3400 Preventive Dental 100% coverage; 2 exams, 3 cleanings plus annual bite-wing x-rays at participating providers. Classic Choice – Dental dental may be added for $22/mo. May live outside of the service area for up to 6 months a year. Coverage for non-emergencies outside the Travel Benefit Option network is 80%. for Seniors SilverSneakers® Fitness Program Members get free and flexible membership to health classes at Community Centers, the – YMCA, LA Fitness, Anytime Fitness and many more including 13,000 nationwide clubs to use when you travel. Check out Fitness Silversneakers.com. UCare Health Club Savings Program Receive up to a $20 reimbursement for membership in participating clubs such as – Lifetime Fitness. This is a brief summary of benefits. Not all covered services, exclusions, and limitations are shown here. Please call the UCare benefit team at 612-676-6900 or 1-877-598-6574 for specific information, or visit .
Eyewear & Hearing Aids Eyewear - $75 annual allowance – High and Core options only. Hearing Aid Benefit - $500 every 36 months – High & Core Options only. Office Visits Primary - $15 copay Specialist - $15 copay Primary - $15 copay Specialist - $30 copay Primary - $15 Specialist - $40 Lab & X-rays 100% coverage 100% coverage 10% coinsurance Inpatient Hospital 100% after $100 copay per admission 100% after $200 copay per admission $300/day copay for days 1-5; then 100% Outpatient Surgery 100% after a $200 copay 100% after a $250 copay 100% after a $250 copay Emergency Care (Worldwide) $50 copay per hospital emergency $75 copay per hospital emergency $75 per hospital emergency SNF 100% coverage for days 1 -20 $100 copay per day for days 21 -100 No 3 day inpatient hospital stay required for coverage. Out of Pocket Maximum $3400 per calendar year for Part A and B Services. Dental Preventive Dental – 100% coverage; 2 exams, 3 cleanings plus annual bite-wing x-rays at participating providers. Classic Choice dental may be added for $22/mo. Travel Benefit Option May live outside of the service area for up to 6 months a year. Coverage for non-emergencies outside the for Seniors network is 80%. Fitness SilverSneakers® Fitness Program – Members get free and flexible membership to health classes at Community Centers, the YMCA, LA Fitness, Anytime Fitness and many more including 13,000 nationwide clubs to use when you travel. Check out Silversneakers.com. UCare Health Club Savings Program – Receive up to a $20 reimbursement for membership in participating clubs such as Lifetime Fitness. This is a brief summary of benefits. Not all covered services, exclusions, and limitations are shown here. Please call the UCare benefit team at 612-676-6900 or 1-877-598-6574 for specific information, or visit .
Ucare%20PEIP%20Retiree%20Health%20comparison%20two%20sided%202017.docx