Page 34 - Benefits-Guide-2020

MEDICAL PLANS | Summary of Benefits | Continued
Supplement-Type Standard Plan
Supplement-Type Enhanced Plan
Medicare Advantage Standard Plan
Medicare Advantage Enhanced Plan
$250 annual deductible.
Member pays 20% of expenses incurred for emergency care during the first 60 days of each trip. Lifetime maximum of $100,000. Member pays 100% thereafter.
$250 annual deductible.
Member pays 20% of expenses incurred for emergency care during the first 60 days of each trip. Lifetime maximum of $100,000. Member pays 100% thereafter.
$250 annual deductible.
Member pays 20% of expenses incurred for emergency care during the first 60 days of each trip. Lifetime maximum of $100,000. Member pays 100% thereafter.
After the plan pays benefits for foreign travel emergency and urgently needed services, you are responsible for the remaining cost.
Emergency or urgently needed care services while traveling outside the United States or its territories during a temporary absence of less than six months.
$250 annual deductible.
Member pays 20% of expenses incurred for emergency care during the first 60 days of each trip. Lifetime maximum of $100,000. Member pays 100% thereafter.
After the plan pays benefits for foreign travel emergency and urgently needed services, you are responsible for the remaining cost.
Emergency or urgently needed care services while traveling outside the United States or its territories during a temporary absence of less than six months.
10% coinsurance.
Member pays $0.
10% coinsurance
for Part B drugs, drug administration, chemotherapy drugs
and chemotherapy drug administration.
Your provider must obtain approval
before you get certain injectable/infusion drugs. This is called getting prior authorization.
10% coinsurance
for Part B drugs, drug administration, chemotherapy drugs and chemotherapy drug administration.
Your provider must obtain approval
before you get certain injectable/infusion drugs. This is called getting prior authorization.
Unless otherwise noted: For the Medicare Advantage Standard Plan, members must meet their calendar-year deductible for all Part A and Part B covered services before their copayment or coinsurance will apply. For the Supplement-Type Standard Plan, members have no deductible to meet for Part A services, but for Part B services, members must meet their calendar-year deductible before their coinsurance will apply.
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PART B DRUGS FOREIGN TRAVEL EMERGENCY CARE