Benefits and Coverage

You're covered to receive preventative and comprehensive dental services. 

Allowances

$3,000 comprehensive allowance per year (combined with preventative). Members are responsible for all costs above the allowance amounts.

Preventive Dental Services

1 oral exam every 6 months; any combination of routine preventive and periodontal maintenance totaling 4 per year; panoramic and full mouth x-rays once every 5 years; and bitewing, periapical and occlusal x-rays once every 6 months.

Comprehensive Dental Services

• Unlimited white (resin) or silver (amalgam) fillings
• Simple tooth extractions
• Crowns limited to 2 per year; 1 crown in 5 years per tooth.
• 2 root canals to treat deep decay to the nerve of the tooth.
• Gum disease treatment services (sometimes called periodontal benefits):
  • Deep cleaning of the teeth to remove deposits under the gums (scaling and root planing) in all areas of mouth as needed (4 quads/visit limit). Limited to every year.
  • Maintaining gum health through maintenance with any combination of routine preventive and periodontal maintenance totaling 4 per year.
  • Removing heavy deposits from teeth (full mouth debridement) covered 1 per year, and not allowed on the same day with regular teeth cleaning or deep cleaning.

Denture Coverage

Dentures 1 per arch every year, including a full denture, partial denture or immediate denture and denture repairs. These are included in the comprehensive maximum.

Medicare-Covered Dental Services

Certain services may be covered when in the hospital. Copays are as follows: $0 copay for Specialists, Outpatient Hospital/ASC Services, and Outpatient Observation Services 

Reminder: Authorization may be required.

How to Use this Benefit

Dental services are provided by United Concordia. Members must receive their services from a participating provider.

You're covered to receive free meal delivery to your home if you've been discharged from an inpatient hospital, rehab facility, or skilled nursing facility. There's a $0 copay for home delivered meals. This benefit covers up to 14 meals over seven days, no limit for the number of admissions.

Allowances

• Up to 14 meals (2 per day for 7 days).
• Meals delivered up to 30 days after being discharged.
• Meals are offered in different dietary packages.
• Meals are low in sodium, fat, cholesterol and are sugar-controlled to accommodate a variety of chronic conditions.
• Renal, kosher, pureed and Halal meals are available upon request.

How to Use this Benefit

Once discharged from the facility, a case manager will reach out to you to coordinate the meal plan and delivery.

You're covered to sign up for fitness programs from FitOn that help build confidence, mobility, and a greater sense of community. 

At the beginning of each month, credits are added to your FitOn account. Credits are tokens that can be used for gym memberships, fitness classes, or other services offered by FitOn Health, including:

• Monthly membership to 13,000 gyms, studios, and community centers: Anytime Fitness, The Y, Gold’s Gym, Curves, LA Fitness, Crunch and more.
• Unlimited digital fitness classes
• Nutritional programs including 500+ exclusive recipes.
• Chronic disease courses and wellness content

Use the FitOn website and app to look up facility locations, meal plans, and healthy recipes, connect with support groups and other resources like on-demand workout and nutrition videos.

Allowances

32 credits per month

How to Use this Benefit

Create a FitOn Health account at FitOnHealth.com/Register. Next, download the FitOn Health app from the Apple App Store or get it on Google Play.

You're covered to receive 1 yearly routine hearing exam. and can schedule unlimited follow-up provider visits within the first year for fitting and adjustment services.

Medicare-Covered Hearing Exams

$0 copay

Routine Hearing Exams

$0 copay

Hearing Aids

1 TruHearing-branded Select Advanced hearing aid per ear, every 3 years, including:

• 80 batteries per hearing aid for non-rechargeable models
• 3-year extended warranty
• Choice of a rechargeable or battery-operated model

Tru-hearing hearing aids are covered by a 3-year manufacturer repair warranty and a 3-year manufacturer loss and damage.

• Unlimited Manufacturer Defect Warranty
• Warranty for loss or personal damage – limited to once per aid per 3-year period – if:
  • Anything causes the aids to no longer be in the member possession. 
  • The hearing aids are not usable from some sort of loss or damage.
• Members should contact their TruHearing provider for more information related to the warranty.

How to Use this Benefit

Hearing benefits are provided by TruHearing. For hearing aids, schedule an appointment with a participating TruHearing audiologist by calling 1-844-763-4240. Hearing aids are limited to TruHearing-branded Select Advanced models. 

You're covered to receive a combined monthly allowance used to pay for healthy groceries, over-the-counter items, utility bills, home and bathroom safety products, and more. 

Allowance

$208 per month. You will be able to spend your monthly allowance in any combination you choose. The monthly allowance will be automatically loaded onto a FlexCard by Mastercard. Treat it like a debit card and use it anywhere that accepts MasterCard. Unused amounts will roll over to the next month.

How to Use this Benefit

• Call 1-833-623-2619, Monday–Friday, 8 a.m.–8 p.m. 
• Visit MyHealthyFlex.com to view balance, purchase history, and more.
• Download the myTotal Benefits app from the Apple App Store or get it on Google Play. Use this app to scan products while shopping to see if the product is eligible for purchase using your FlexCard. No smartphone? No problem. Call 1-833-623-2619 to order a catalog.

You're covered for all $0 prescription drug copays:

• Zero-dollar ($0) copay on prescriptions for all tiers (1-5)
• $0 copay during all prescription drug benefit phases

Note: Applies to Part D drugs only.

Read more about your medication benefits.

You're covered for 36 one-way rides to:

• Health-related visits within a 60-mile radius (example: doctor offices, pharmacy, other medical appointments, etc.)
• Nonhealth-related visits within a 30-mile radius (example: gym, grocery store, etc.)

Allowances

 Additional mileage to health locations allowed with plan approval.

You pay $0 copay for 36 one-way trips to plan approved locations. Mileage reimbursement is available when a personal car is used. Trip limit of 60-mile radius one way for medical trips and limit of 30 mile radius one way for non-medical trips. Extra mileage up to 80 miles can be granted with prior approval based on plan limits for medical related trips only.

How to Use this Benefit

Call Member Services to schedule the kind of pick-up and drop-off service you need. Here are the options:

• Door to Door: driver meets members at the door. Door to Door service is the best option if a member does not have a cell phone able to receive text messages.
• Curb to Curb: driver meets members at the curb.

You should be ready 60 minutes in advance of the pickup time.

A trip will be counted toward the your allowance if the ride is missed, or if you fail to board the vehicle at requested time, or if a scheduled ride is not canceled at least 2 hours prior to dispatching.

Wheelchair accommodation is available on request of the member. Wheelchair accommodation is not available for Rideshare (Uber).

You're covered to receive a yearly routine vision exam, including eyeglasses (including both frames and lenses) or contacts. You are limited to 1 pair of lenses and frames or contact lenses each year. The following eyeglass lenses are covered: single vision, lined bifocals, lined trifocals, and lenticular.

Routine Eye Exams

$0 copay, 1 per year

Medicare-Covered Eye Exams

$0 copay

Allowances for Frames or Contacts

$400 allowance toward any brand frames or contacts. Covered lens upgrades: scratch-resistant coating, oversized lenses, tints, standard progressives, photochromic lenses, UV coating, and polycarbonate lenses.

Reminder: Members are responsible for all costs over the yearly allowance and what the plan covers for upgrades.

How to Use this Benefit

Dental services are provided by VSP Vision Care. Members should schedule an appointment with a VSP Vision Care participating provider. No vision benefit card is required. To schedule an appointment, call VSP Vision Care at 1-866-412-5825. Member may also search for a participating provider using the VSP provider search.