X hits on this document

PDF document

Providence Health Plan is a health plan with a Medicare contract. - page 11 / 32

73 views

0 shares

0 downloads

0 comments

11 / 32

SUMMARY OF BENEFITS

If you have any questions about this plan’s benefits or costs, please contact Providence Health Plan.

Benefit Category

Original Medicare

Providence Medicare Extra + RX

OUTPATIENT MEDICAL SERVICES AND SUPPLIES (continued)

18 - Durable Medical

20% coinsurance

General

Equipment

Authorization rules may apply.

(includes wheelchairs, oxygen, etc)

In-Network

10% of the cost for Medicare- covered items.

19 - Prosthetic Devices

(includes braces, artificial limbs and eyes, etc)

20% coinsurance

General Authorization rules may apply.

In-Network

10% of the cost for Medicare- covered items.

20 - Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies

(includes coverage for glucose monitors, test strips, lancets, screening tests, self-management training, retinal exam/glaucoma test, and foot exam/therapeutic soft shoes)

20% coinsurance

Nutrition therapy is for people who have diabetes or kidney disease (but aren't on dialysis or haven't had a kidney transplant) when referred by a doctor. These services can be given by a registered dietitian or include a nutritional

assessment and counseling to help you manage your diabetes or kidney disease.

In-Network

$0 copay for Diabetes self-monitoring training.

$0 copay for Nutrition Therapy for Diabetes.

$0 copay for Diabetes supplies.

11

Document info
Document views73
Page views73
Page last viewedWed Dec 07 15:17:31 UTC 2016
Pages32
Paragraphs574
Words8210

Comments