Group Medicare summary of benefits
Review benefits
A list of the benefits available in the group
PriorityMedicare Basic and Enhanced plans.
Contact your account representative or your independent agent for more information.
| Priority Health Medicare plans |
| Rate guarantee: |
For 12 months from the effective date of coverage, or to the renewal date of the traditional carrier, whichever is sooner. |
|
Basic Plan |
Enhanced Plan |
Benefit levels
Basic agreement, with: |
- $15 office visit copay for primary care physicians at HMO benefit level
- $30 office visit copay for specialists at HMO benefit level
- 70/30% office visit copay for primary care physicians and specialists at POS benefit level
- $45 urgent care copay
- 100% hospital coverage at HMO benefit level
- 70/30% hospital coverage at POS benefit level
|
- $10 office visit copay for primary care physicians at the HMO benefit level
- $25 office visit copay for specialists at the HMO benefit level
- 80/20% office visit copay for primary care physicians and specialists at POS benefit level
- $40 urgent care copay
- 100% hospital coverage at HMO benefit level
- 80/20% hospital coverage at POS benefit level
|
| Deductibles: |
- $250 medical deductible at HMO benefit level
- $1000 medical deductible at POS benefit level
|
- $0 medical deductible at HMO benefit level
- $500 medical deductible at POS benefit level
|
| Riders: |
- $15/$50, $80/20% prescription drug copay
- Mail order: 90-day supply at two times the Rx copay
- 80% prosthetic & orthotics coverage at HMO benefit level
- 50% prosthetic & orthotics coverage at POS benefit level
- 80% durable medical equipment coverage at HMO benefit level
- 50% durable medical equipment coverage at POS benefit level
- $65 emergency room copay
- $100 ambulance copay
- $6,700 Out-of-Pocket Maximum at HMO Benefit Level
- Unlimited Individual Lifetime Benefit at HMO Benefit Level
- $6,700 Out-of-Pocket Maximum at POS Benefit Level
- $1,000,000 Individual Lifetime Benefit Maximum at POS Benefit Level
|
- $10/$40, $70/20% prescription drug copay
- Mail order: 90-day supply at two times the Rx copay
- 80% prosthetic & orthotics coverage at HMO benefit level
- 50% prosthetic & orthotics coverage at POS benefit level
- 80% durable medical equipment coverage at HMO benefit level
- 50% durable medical equipment coverage at POS benefit level
- $65 emergency room copay
- $100 ambulance copay
- $6,700 out-of-pocket maximum at HMO benefit level
- Unlimited individual lifetime benefit at HMO benefit level
- $6,700 out-of-pocket maximum at POS benefit level
- $1,000,000 individual lifetime maximum at POS benefit level
|
