Page 38 - Demo

MEDICARE ADVANTAGE MEDICAL PLANS | Summary of Benefits | Continued
Medicare Advantage Standard Plan
Medicare Advantage Enhanced Plan
Medicare Advantage Enhanced Plus
$40 copay for the one time only hospice consultation.
Deductible does not apply.
When you enroll in a Medicare- certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan.
$25 copay for the one time only hospice consultation.
When you enroll in a Medicare- certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan.
$0 copay for the one time only hospice consultation.
When you enroll in a Medicare- certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan.
Plan deductible applies.
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.
No deductible applies.
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 for Medicare- covered Part B drugs.
Member pays $0 for the pneumonia, influenza, hepatitis B, or other Medicare-covered vaccines.
10% coinsurance for Medicare- covered Part B drugs.
Member pays $0 for the pneumonia, influenza, hepatitis B, or other Medicare-covered vaccines.
10% coinsurance for Medicare- covered Part B drugs.
Member pays $0 for the pneumonia, influenza, hepatitis B, or other Medicare-covered vaccines.
If your Medical Plan has a deductible, it must be met before copayments or coinsurance will apply. See page 42 for details regarding Prescription Drug Plan deductible, copays and coinsurance.
38 | Insurance Trust For Delta Retirees | 2021 Benefits & Resources Guide
PART B DRUGS
FOREIGN TRAVEL EMERGENCY CARE HOSPICE CARE