Additional information
| Plan Premium | $0 |
|---|---|
| Medical Deductible (Part A) | $0 |
| Prescription Drug Deductible (Part D) | $0 |
| Maximum-Out-of-Pocket | $888 |
| Prescription Drugs (Part D) | Included* |
| Doctor Visits | $0 copay |
| Hospital Stay | $0 copay unlimited days |
| Transportation (Non-Emergency) | $0 copay for 28 one-way trips |
| Flexible Health and Wellness Allowance | $100 allowance every three months |
| Labs/X-ray | $0 copay |
| Dental Coverage | Up to $2000 per year |
| Routine Vision and Eyewear Coverage | $0 copay | $480 every two years |
| Hearing Coverage | $0 copay | $500 per ear every year |
| Acupuncture | $0 copay |
| Eastern Wellness Therapies | $0 copay up to 12 services per year |
