2007 Benefit Highlights – Vision and
Dental
Dental and Vision
Benefits for Value Rx, Value Rx+ and Freedom Rx+ members
Vision Benefit
Vision services are included in the Value Rx, Value Rx+ and Freedom Rx+ options
only. 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.
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SENIOR CARE PLUS
HIGHLIGHTS
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VISION
HIGHLIGHTS
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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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$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
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0% of the cost, limited to once every year
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0% of the cost, limited to once every year
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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 $100
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Dental Benefit
Comprehensive dental services are included in the Value Rx+ and Freedom Rx+
options only. Dental Coverage includes preventive, basic, and major dental
services. A deductible and coinsurance apply for basic and major services. There is a $1,000 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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$1,000 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
