Summary of Benefits - SCAN Health Plan
Summary of Benefits - SCAN Health Plan
Summary of Benefits - SCAN Health Plan
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Benefit Original Medicare <strong>SCAN</strong> CLASSIC (HMO) <strong>SCAN</strong> OPTIONS (HMO)<br />
30<br />
Outpatient Medical Services and Supplies (cont.)<br />
28. Vision Services 20% coinsurance for diagnosis<br />
and treatment <strong>of</strong> diseases and<br />
conditions <strong>of</strong> the eye.<br />
Supplemental routine eye exams<br />
and glasses not covered.<br />
Medicare pays for one pair <strong>of</strong><br />
eyeglasses or contact lenses after<br />
cataract surgery.<br />
Annual glaucoma screenings<br />
covered for people at risk.<br />
General<br />
Authorization rules may apply.<br />
In-Network<br />
$10 copay for one pair <strong>of</strong><br />
Medicare-covered eyeglasses<br />
or contact lenses after<br />
cataract surgery.<br />
$0 to $10 copay for Medicarecovered<br />
exams to diagnose and<br />
treat diseases and conditions <strong>of</strong><br />
the eye.<br />
$0 copay for up to 1 supplemental<br />
routine eye exam(s) every year<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
glasses every two years<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
contacts every two years<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
lenses every two years<br />
$35 copay for up to 1 frame(s)<br />
every two years<br />
$105 plan coverage limit for<br />
contact lenses every two years.<br />
$105 plan coverage limit for eye<br />
glass frames every two years.<br />
General<br />
Authorization rules may apply.<br />
In-Network<br />
$10 copay for one pair <strong>of</strong><br />
Medicare-covered eyeglasses<br />
or contact lenses after<br />
cataract surgery.<br />
$0 to $10 copay for Medicarecovered<br />
exams to diagnose and<br />
treat diseases and conditions <strong>of</strong><br />
the eye.<br />
$0 copay for up to 1 supplemental<br />
routine eye exam(s) every year<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
glasses every two years<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
contacts every two years<br />
$35 copay for up to 1 pair(s) <strong>of</strong><br />
lenses every two years<br />
$35 copay for up to 1 frame(s)<br />
every two years<br />
$105 plan coverage limit for<br />
contact lenses every two years.<br />
$105 plan coverage limit for eye<br />
glass frames every two years