b'UnitedHealthcare Group Medicare Advantage PPOHumana Group Medicare HMOwith Express Scripts Medicare (PDP) for CTPF Medicarewith Part D Pharmacy Medicare Advantage planAdvantage planOUTPATIENT SERVICES OUTPATIENT SERVICESChemotherapy, Radiation100% after deductible Chemotherapy, Radiation$50 Copay chemotherapy drugs. Radiation covered Emergency Room $50 100% outpatient hospital, $25 copay for specialist office.Lab/X-Ray100% after deductible Emergency Room $50 Copay emergency room; waived if admitted Speech, Physical & Occupational Therapy,within 24 hours; applies for care outside USOutpatient Rehab100% after deductible Lab/X-RaySurgery100% after deductible 100% covered except urgent care, $25 Copay urgent careUrgent Care100% after deductible Speech, Physical & Occupational Therapy, PROFESSIONAL & OTHER SERVICES Outpatient Rehab100% per visit after $25-$40 copayAmbulance100% after deductible (based on where services are rendered)Allergy Shots100% after deductible SurgeryChiropractic Visits100% after deductible (unlimited visits);$100Copay per visit in hospitalMedicare covered services $75Copay per visit in ambulatory surgical facilityDental100% after deductible; Medicare covered services only Urgent Care Diabetic Part B Covered Supplies100% covered $25CopayHearing PROFESSIONAL & OTHER SERVICESMedicare-covered Services: 100% after deductible Ambulance$50 Copay per date of serviceRoutine (Non-Medicare) Services: $0 copay routine Allergy ShotsNo copayhearing examHearing Aids: $1,000 allowance purchased in networkChiropractic Visits$20 Copay;through UnitedHealthcare Hearing every three years Medicare guidelines applyHome Health Services100% after deductible Dental$25 copay (Medicare covered services only)Physician Office Visits100% after deductible Diabetic Part B Covered Supplies100% coveredPreventive Care (physicals, diagnostics, someHearing$10 Copay at PCP, $25 copay specialist, immunizations)100% covered(1 physical per plan year) Medicare covered services only.Prosthetic Devices, Med. Equip100% after deductible Home Health ServicesNo copay (prior authorization Podiatryrequired) excludes personal home careMedicare-covered Services100% after deductible Physician Office VisitsRoutine (Non-Medicare) Services100% after deductible,$10 Copay PCP,$25 Copay specialist6 visits per year Preventive Care (physicals, diagnostics, Renal Dialysis100% after deductible immunizations)No copayTransplants100% after deductible Prosthetic Devices, Med. Equip10% at medical equipment provider or pharmacyVision ServicesPodiatry$25 Copay; Medicare covered services onlyMedicare covered Services: 100% after deductible; Eye Wear: $0 copay Medicare covered standard eyeglassRenal DialysisNo copay in dialysis center; 20% at lenses and frames after cataract surgery.hospitalRoutine (Non-Medicare Covered) Services: $0 copay annualTransplantsAs any other disease at Medicare-routine eye exam; $300 eye wear allowance every two years. approved Humana National Transplant Network only Extra Benefits (wellness, discounts) $60/quarter over theVision Services$25 Copay; Medicare covered counter benefit, HouseCalls, Renew Active fitness, hearing aidservices only discount, Wellness programs, Renew Rewards and more.Extra Benefits (wellness, discounts)Contact carrier CTPF 2023 HEALTH INSURANCE HANDBOOKContact carrier for more benefit details. for extra benefit details. EALTH INSURANCE HANDBOOK CTPF 2023 H 35'