Page 18 - ITDR Benefits & Resources guide 2019

MEDICAL P
LAN
SUPPLEMENT-TYPE PLAN
MEDICARE ADVANTAGE STANDARD PLAN
MEDICARE ADVANTAGE ENHANCED PLAN
FOREIGN TRAVEL EMERGENCY CARE
Deductible applies to all services with copays under the Medicare Advantage Standard Plan.
$250 annual deductible. 20% of expenses incurred for emergency care during the first 60 days of each trip. Lifetime maximum of $100,000.Member pays 100% thereafter.
Overall $750 deductible applies
$250 deductible per lifetime
20% coinsurance for emergency care and urgently needed services
20% coinsurance per admission for emergency inpatient care
Foreign travel benefits are limited to a $100,000 maximum benefit per lifetime.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.
MEDICARE PART B DRUGS
Deductible applies to all services with coinsurance under the Supplement-Type Plan.
For the Medicare Advantage Standard Plan and the Medicare Advantage Enhanced Plan, your provider must obtain approval from the plan before you get certain injectable/infusible drugs.
This is called getting prior authorization. Ask your provider or call the plan to learn which drugs apply.
10% coinsurance.
10% coinsurance for Part B drugs, drug administration, chemotherapy drugs and chemotherapy drug administration.
LIVEHEALTH ONLINE
When your own doctor isn’t available or you are traveling, LiveHealth Online is a quick and easy way to visit with a doctor or therapist through live, two-way video on your computer or mobile device. Visit www.livehealthonline.com for more information.
$0 copay.
$0 copay.
$0 copay.
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