2015-025D - Laserfiche WebLink

Home Browse Search

B Fterr�,.�` ;Etta �� i i✓a In the pursuit of health' 1. `e k Benefrts s T 4 k j BIueNPeI are, mu Pha n 1 z } Medicare -covered stay in a network psychiatric hospital 190 -day lifetime limit in a psychiatric hospital Out -of -Network CYD & 20% Skilled Nursing Facility (in a Medicare -certified skilled nursing facility) In -Network • $0 copay each day for days 1-20 per benefit period • $75 copay each day for days 21-100 per benefit period There is a limit of 100 days for each benefit period 3 -day prior hospital stay is not required Out -of -Network CYD & 20% Hospice Member must receive care from a Medicare - certified hospice .,z s+ Ye•p'{'S ivpgyk:.S' Sv'eKd< C l 'L ... S.. Annual Screening Mammograms (for women with Medicare age 40 and older) In -Network: • $0 copay for Medicare -covered Screening Mammogram Out -of -Network CYD & 20% Pap Smears and Pelvic Exams (for women with Medicare) In -Network: • $0 copay per Pap smear • $0 copay per pelvic exam Out -of -Network CYD & 20% Bone Mass Measurement (for people with Medicare who are at risk) In -Network: • $0 copay for each Medicare -covered Bone Mass Measurement Out -of -Network CYD & 20% Colorectal Screening Exams (for people with Medicare age 50 and older) In -Network: • $0 copay for Medicare -covered Colorectal screening exam Out -of -Network CYD & 20% Prostate Cancer Screening Exams (for men with Medicare age 50 and older) In -Network: • $0 copay for Medicare -covered Prostate Cancer Screening exam Out -of -Network CYD & 20% Vaccines — Medicare covered In -Network / Out -of -Network • $0 copay for Influenza vaccine • $0 copay for Pneumococcal vaccine • $0 copay for Hepatitis B vaccine }'' Health & Wellness Benefit Fitness Free membership through SilverSneakers Y0011_31917 0913R2 EGWP C: 09/2013 4