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第一保健增進福利計劃 Increased Benefits Plan

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第一保健增進福利計劃(Increased Benefits Plan)(管理式保健計劃)

第一保健增進福利計劃(Increased Benefits Plan)除了提供傳統老人醫療保險的福利之外,還另外提供廣泛的福利,包括預防性與全面的牙科、聽覺承保與助聽器、視覺承保、眼鏡或隱形眼鏡、針灸、常規交通、非處方藥(OTC)用款額度、出院後的餐食、SilversSneakers®健身計劃,以及每週七天每天24小時獲取Teladoc(遠程醫療)護理和使用護士協助專線服務。

如果您符合全額額外補助(Extra Help),又稱為低收入補貼(Low Income Subsidy))與/或老人醫療保險保費減免計劃(Medicare Savings Program,簡稱MSP)的資格,本計劃可能最適合您。如果您符合全額低收入補貼﹐您將符合條件享受$0的每月保費﹐配藥無需支付自付扣除金﹐並且享受較低的處方配藥定額手續費。

您怎樣才能符合資格參加此項計劃?

您享有老人醫療保險A部份與老人醫療保險 B部份

您住在紐約市,或住在拿索郡、羅克蘭、威徹斯特郡、橘郡或沙利文郡

您是美國公民或合法在美國居留者

增進福利計劃計劃重點

點擊此處查看計劃詳情

  • 低價或沒有Copay的處方藥
  • 綜合牙科(無上限)
  • 聽力檢查及助聽器(一對助聽器,每隻耳朵高達$1,475/年)
  • 視力檢查及眼鏡($200/年)
  • 可購買非處方項目的自選藥物與用品(OTC $20/月)福利金
  • 免費交通接送看診(40次/年)
  • 針灸
  • (如住院2天或以上 出院後)可獲高達28天84次的送餐到家服務

2022 Enhancements

  • Coverage for prescription vitamins and $0 for preferred generics
  • Simplified eyewear, dental, and hearing benefits
  • Reduced specialist copay to $30 (from $40)
  • Expanded coverage for worldwide emergent/ urgent care to $200k (from $100k)
  • Increased OTC allowance to $20/mo  (from $15/mo)

Key benefit and cost-sharing changes

Increased Benefits Plan 2021 2022
SNF (Skilled Nursing Facility) $184 each day for days 21-100 $188 each day for days 21-100
Worldwide Emergency/Urgent Coverage Worldwide transportation: $225 Worldwide transportation: $250
Worldwide Emergency/Urgent Maximum Plan Benefit Coverage Limit Yes
$100,000
Yes
$200,000
Physician Specialist $40 $30
 Retail Health Clinic  $10 $10
Medicare Covered X-rays $15
Separate office visit copay applies
$25
Separate office visit copay applies
Outpatient Diagnostic Radiology Services $50
Separate office visit copay applies
$60
Separate office visit copay applies
Ground Ambulance $225 $250
Air Ambulance $225 $250
Supplemental Acupuncture $0
15 visits every year
$0
12 visits every year
Over the Counter Items $15/month = $180/year No Rollover $20/month = $240/year
No Rollover
Health Education $0 Not covered
Supplemental Comprehensive Dental Dentures, Root canals, crowns & extractions covered based on medical necessity Medical necessity criteria removed for dentures, root canals, crowns and extractions
Prosthodontics, Other Oral/Maxillofacial Surgery/Other services Implants covered Implants no longer covered
Medicare Covered Eye Exams $40 $30
Eye Wear $0
1 every year Medically necessary contact lenses OR Fashion Frames: $0 copay OR Designer Frames: $0 copay OR Premier Frames: $20 copay OR Non-Plan Frames: $175 benefit allowance OR Elective Contact Lenses: $175 benefit allowance(1 every year)
$0
Copay for plan frames (fashion, designer or premier), $0 copay for single vision, bifocal, trifocal lenses for glasses, $0 copay for medically necessary contact lenses OR $200 allowance for non-plan frames and elective contact lenses every year
Medicare-Covered Hearing Exams $40 $30
Hearing Aids (all types) $0
Plan covers up to $1000 max ($500 per ear) every 3 years
Copays per aid by technology level:
Entry $0
Basic $175
Prime $475
Preferred $775
Advanced $1075
Premium $1475
Plan covers 2 hearing aids every year

更多關於“第一保健增進福利計劃”的詳細資訊可查閱以下鏈接:

https://zh.healthfirst.org/increased-benefits-plan/#2022

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