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C AND O EMPLOYEES’ HOSPITAL ASSOCIATION
MEDICARE SUPPLEMENTAL PLAN
2010 SUMMARY OF BENEFITS
PLAN SEVEN
|
COEHA Medicare Supplemental Plan Benefits |
COEHA Medicare Supplemental Plan Payment |
|
Annual Part A Deductible |
$1100.00 |
|
Annual Part B Deductible |
$155.00 |
|
Ambulance |
100% coinsurance when covered |
|
Chemotherapy/Radiation Services |
100% coinsurance |
|
Chiropractic Services |
100% coinsurance |
|
Diabetic Testing Supplies |
100% coinsurance for test strips, lancets, lancing devices
and control solution when purchased through Neighborhood Diabetes |
|
Durable Medical Equipment |
100% coinsurance when covered |
|
Emergency Room Services |
100% coinsurance |
|
Inpatient Hospital Care |
100% coinsurance |
|
Kidney Dialysis |
100% coinsurance |
|
Long Term Care Physician Visits and Physical Therapy |
100% coinsurance |
|
Mental Health Services |
100% coinsurance |
|
Office Visits |
100% coinsurance |
|
Ophthalmology Services |
100% coinsurance |
|
Organ Transplants |
Up to $100,000 coinsurance per lifetime |
|
Outpatient Surgery, Diagnostic & Therapeutic Services |
100% coinsurance |
|
Physical Therapy, Occupational & Speech Therapy |
100% coinsurance |
|
Podiatry Services |
100% coinsurance |
|
Prescription Drugs – our Pharmacy Benefit Manager is
Informed RX |
See the COEHA Medicare Part D Plan Summary of Benefits for
2010 |
|
Skilled Nursing Facility |
100% coinsurance |
COEHA benefits supplement your basic Medicare benefits. Services
denied by Medicare are not covered by COEHA. Also, not all services covered by
Medicare are a COEHA benefit. For more details, please refer to your Medicare
& You 2010 and C and O Employees’ Hospital Association Medicare
Supplemental Handbooks. For more details regarding our Medicare Part D
Prescription Drug Plan, please refer to the C and O Employees’ Hospital
Association Medicare Part D Prescription Drug Plan Evidence of Coverage for
2010.
C AND O EMPLOYEES’ HOSPITAL ASSOCIATION
MEDICARE SUPPLEMENTAL PLAN
2010 SUMMARY OF BENEFITS
PLAN TEN
|
COEHA Medicare Supplemental Plan Benefits |
COEHA Medicare Supplemental Plan Payment |
|
Annual Part A Deductible |
$1100.00 |
|
Annual Part B Deductible |
$155.00 |
|
Ambulance |
100% coinsurance when covered |
|
Chemotherapy/Radiation Services |
100% coinsurance |
|
Chiropractic Services |
100% coinsurance |
|
Diabetic Testing Supplies |
100% coinsurance for test strips, lancets, lancing devices
and control solution when purchased through Neighborhood Diabetes |
|
Durable Medical Equipment |
100% coinsurance when covered |
|
Emergency Room Services |
100% coinsurance |
|
Inpatient Hospital Care |
100% coinsurance |
|
Kidney Dialysis |
100% coinsurance |
|
Long Term Care Physician Visits and Physical Therapy |
100% coinsurance |
|
Mental Health Services |
100% coinsurance |
|
Office Visits |
100% coinsurance |
|
Ophthalmology Services |
100% coinsurance |
|
Organ Transplants |
Up to $100,000 coinsurance per lifetime |
|
Outpatient Surgery, Diagnostic & Therapeutic Services |
100% coinsurance |
|
Physical Therapy, Occupational & Speech Therapy |
100% coinsurance |
|
Podiatry Services |
100% coinsurance |
|
Skilled Nursing Facility |
100% coinsurance |
COEHA benefits supplement your basic Medicare benefits. Services
denied by Medicare are not covered by COEHA. Also, not all services covered by
Medicare are a COEHA benefit. For more details, please refer to your Medicare
& You 2010 and C and O Employees’ Hospital Association Medicare
Supplemental Handbooks.
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