2008 Benefit Highlights - Vision and Dental
Dental and Vision Benefits for Value, Value Plus, Value Rx, Value Rx+ and Freedom Rx+ members
Vision
Benefit
Vision services are included in the Value, Value Plus, Value Rx, Value Rx+ and Freedom Rx+ options. There is routine eye exam and eye wear coverage that includes a routine eye checkup, copayments for office visits to an optometrist, and contacts or lenses coverage with no copayment. Also, frames are covered up to $100 or $125 depending on the plan.
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SENIOR CARE PLUS
HIGHLIGHTS
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VISION
HIGHLIGHTS
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VALUE PLAN
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VALUE PLUS
PLAN
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VALUE Rx PLAN
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VALUE Rx+
PLAN
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FREEDOM Rx+
PLAN
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Optometrist Office Visits
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$20 copay per visit
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$20 copay per visit
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$20 copay per visit
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$15 copay per visit
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$15 copay per visit
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Contacts or Lenses
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0% of the cost, limited to every two years (up to $100
for contacts)
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0% of the cost, limited to every two years (up to $100
for contacts)
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0% of the cost, limited to every two years (up to $100
for contacts)
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0% of the cost, limited to once every year (up to $100
for contacts)
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0% of the cost, limited to once every year (up to $100
for contacts)
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Frames
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0% of the cost, limited to every two years up to $100
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0% of the cost, limited to every two years up to $100
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0% of the cost, limited to every two years up to $125
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0% of the cost, limited to every two years up to $125
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0% of the cost, limited to every two years up to $125
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Dental Benefit
Preventive dental services can be added to the Value, Value Plus and Value Rx options
only. Dental Coverage includes preventive only dental services for an
additional $15 per month.
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SENIOR CARE PLUS
HIGHLIGHTS
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DENTAL HIGHLIGHTS
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VALUE, VALUE
PLUS and VALUE Rx PLANS
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Extra Premium (in addition to monthly medical and
pharmacy premiums)
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$15 additional premium per month for preventitive
dental benefits
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Preventive Services (oral exams, cleanings, and
x-rays)
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No copayment. Oral exams limited to two visits every year,
cleanings limited to two visits every year, and x-rays once a year.
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Comprehensive dental services are included in the Value Rx+
and Freedom Rx+ options only for no additional premium. Dental Coverage
includes preventive, basic, and major dental services. A deductible and
coinsurance apply for basic and major services. There is a $1,500 maximum yearly benefit.
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SENIOR CARE PLUS
HIGHLIGHTS
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DENTAL
HIGHLIGHTS
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VALUE Rx+ and
FREEDOM Rx+ PLANS
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Preventive Services (oral exams, cleanings, and
x-rays)
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No copayment. Oral exams limited to two visits every year,
cleanings limited to two visits every year, and x-rays once a year.
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Basic Services
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$50 deductible
20% coinsurance for most services.
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Major Services
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$50 deductible
50% coinsurance for most services.
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Annual Maximum Benefit
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$1,500 for comprehensive dental services every year.
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Certain limitations apply for these benefits. For
further details, please call Senior Care Plus or send an e-mail to SCPlus@hometownhealth.com.
Revised October 2007
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