That's why we're here to help you with things like:
Look in the 2025 Evidence of Coverage for Highmark Health Options Duals (HMO SNP) benefits and coverage details. The latest Evidence of Coverage has all the details you need to make the most of your plan.
Ask a nurse about the kind of care you need.
Call the 24-hour Nurse Line at 1-855-401-8251 (TTY: 711). Receive coaching and advice from a health care expert about:
If you’re having a medical emergency, call 911. If you're having a mental health emergency, call 988.
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
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.
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:
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.
32 credits per month
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
Hearing Aids
1 TruHearing-branded Select Advanced hearing aid per ear, every 3 years, including:
Tru-hearing hearing aids are covered by a 3-year manufacturer repair warranty and a 3-year manufacturer loss and damage.
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.
You're covered for all $0 prescription drug copays:
Note: Applies to Part D drugs only.
Read more about your medication benefits.
You're covered for 36 one-way rides to:
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.
Call Member Services to schedule the kind of pick-up and drop-off service you need. Here are the options:
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
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.
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.
Have questions about your Highmark Health Options Duals benefits and coverage? Our care team can make it easier to get what you need. Call 1-855-401-8251 (TTY: 711 or 1-800-232-5460). Our hours are Oct. 1 through March 31: 7 days a week, 8 a.m. – 8 p.m. and April 1 through Sept. 30: Monday – Friday, 8 a.m. – 8 p.m.
Highmark Health Options Duals is offered by Highmark Blue Cross Blue Shield. Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website Best Available Evidence H7710_24_4461_M Last updated on Oct. 1, 2024.