is a Medicare Advantage (Part C) Plan by Martins Point Generations Advantage. Any information we provide is limited to those plans we do offer in your area. Alliance (HMO) plan members in all Maine and New Hampshire counties: $180 per quarter. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. Martin's Point Generations Advantage is a health plan with a Medicare contract offering HMO, HMO-POS, HMO SNP, Local and Regional PPO products. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. 20 year Veteran Army Officer. Premium: $53.00 Enroll Now This page features plan details for 2022 Martin's Point Generations Advantage Flex (Regional PPO) R0802 - 001 - 0 available in Northern New England (New Hampshire and Maine). Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. Click to Call 1-877-354-4611 TTY 711. area. When Ennis Green, the president of Bouvet Springs, Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. R0802 001 0 available in Northern New England (New Hampshire and Maine). Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). Maine Medicare Plans by Martin's Point Generations Advantage in Maine Select your county to view plans and prices available in your area Medicare Advantage Health Plans Medicare-Medicaid Dual Eligible D-SNP Prescription Drug Plans (Part D) Medicare Supplement (Medigap) Medicare-Medicaid Dual Eligible Medicare Advantage Plans (D-SNP) Click to Call 1-877-354-4611 TTY 711. Contact a plan for a Summary of Benefits. Once you reach that amount, you will enter the next coverage phase. With our dental coverage, there's no waiting periodso you can start using your benefit as soon as you need it and low or no copays and coinsurance amounts make important preventive care affordable. Liability for amounts held under uninsured plans 0 1,227,556 23. Martins Point Generations Advantage Flex (Regional PPO) To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . Staying Healthy: Screenings, Tests and Vaccines, Members Whose Plan Did an Assessment of Their Health Needs and Risks, Yearly Review of All Medications and Supplements Being Taken, Yearly Pain Screening or Pain Management Plan, Osteoporosis Management in Women Who Had a Fracture, Eye Exam to Check for Damage from Diabetes, Kidney Function Testing for Members with Diabetes, Plan Members with Diabetes Whose Blood Sugar Is under Control, The Plan Makes Sure Member Medication Records Are Up-to-Date after Hospital Discharge, The Plan Makes Sure Members with Heart Disease Get the Most Effective Drugs to Treat High Cholesterol, Ease of Getting Needed Care and Seeing Specialists, Health Plan Provides Information or Help when Members Need It, Coordination of Members' Health Care Services, Member Complaints and Changes in the Health Plan's Performance, Complaints about the Health Plan (More Stars Are Better because It Means Fewer Complaints), Members Choosing to Leave the Plan (More Stars Are Better because It Means Fewer Members Choose to Leave the Plan), Improvement (if Any) in the Health Plan's Performance, Health Plan Makes Timely Decisions about Appeals, Fairness of the Health Plan's Appeal Decisions, Based on an Independent Reviewer, Availability of TTY Services and Foreign Language Interpretation when Prospective Members Call the Health Plan. Contact a plan for a Summary of Benefits. We do not directly sell health insurance or offer professional legal, medical, or financial advice. Read More. Sessions last about one hour. How to use this benefit: Each quarter, you can make qualifying purchases in person at several Maine CVS stores, by phone, or online. We do not feature every plan available in your area. See the Part D Premium Reduction section below for more details. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Generations Advantage Value Plus (HMO) offers comprehensive medical and hospital benefits and Part D Prescription Drug coverage. IMPORTANT: This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP). Join us for a free Medicare Seminar and Q&A session about the Generations Advantage Plan at Martins Point Health Care, Portland, Maine. We only use data released publicly each year. Ready to sign up for Martins Point Generations Advantage Flex (Regional PPO) also provides the following benefits. Those who disenroll For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), The company's. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. Martins Point Generations Advantage Prime (HMO-POS) 2022 Value Plus (HMO) Medicare Advantage Plan - Martin's Point 2022 Value Plus (HMO) Plan This is of the few plans in the country to receive 5 stars from Medicare, earning Medicare's highest quality rating! Factsonmedicare.com is a free-to-use informational website. Martin's Point Generations Advantage Select; Drug Coverage: Plan Type: PPO: Total Monthly Premium: $99.00: Health Plan Premium: $64.00: Drug Plan Premium: $35.00 Standard Part B Premium: $148.50: Max You Pay for Health Services (in-network) Part D Deductible: $0.00 Learn More gcse.type = 'text/javascript'; Medicare has neither reviewed nor endorsed the information on our site. How this plan performs for drug pricing, patient safety, member experience and more. The Martin's Point Generations Advantage Dental Benefit is administered by Northeast Delta Dental (NEDD). Martins Point Generations Advantage Flex (Regional PPO) Providers who do not contract with the plan are not required to see you except in an emergency. Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Five of the Martin's Point Generations Advantage plans offer Medicare Part D prescription drug coverage. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, Inc Live help. Please contact the plan for further details. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. The following Martin's Point Generations Advantage plans offer Medicare Advantage Prescription Drug plan coverage to Maine residents. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service Book a meeting space online. Call (888) 640-4423 (TTY: 711). Martins Point Generations Advantage Prime (HMO-POS) After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs. . What to Consider When Shopping for Medicare, Martin's Point Generations Advantage Value Plus H5591-009 (HMO), $425 per day for days 1 through 5 / $0 per day for days 6 through 90, $365 per day for days 1 through 5 / $0 per day for days 6 through 90, $0 per day for days 1 through 20 / $196 per day for days 21 through 100, Best Continuing Care Retirement Community (CCRC), Best Medicare Advantage Plan Companies 2023, Medicare Advantage Plus Prescription Drug Plans in Maine, Medicare Advantage Plus Prescription Drug Plans in 04471 (Aroostook County), Martin's Point Generations Advantage Medicare Advantage Plus Prescription Drug Plans in Maine, Find Continuing Care Retirement Communites, California Do Not Sell My Personal Information Request. Martins Point Generations Advantage Prime (HMO-POS) U.S. News does not have a relationship with, or receive remuneration from Martin's Point Generations Advantage. Generations Advantage Prime (HMO-POS), Select (LPPO), Focus DC (HMO SNP), and Value Plus (HMO) plans have Part D prescription drug coverage built right into the plan. Martin's Point Generations Advantage Claims Department PO Box 11410 Portland, ME 04104-9863 Step 5: Be on the look out for this envelope in your mailbox. When your annual out-of-pocket costs exceed $6,350. Please contactwww.medicare.govor1-800-MEDICARE(TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information about Medicare plan options. Are you turning 65 or already on Medicare but curious about Generations Advantage plans? Locations Posted 11/8/2022. })(); 2023 Martin's Point Generations Advantage Alliance (HMO) in York, Maine, Find a 2023 Medicare Advantage Plan (Health and Health w/Rx Plans), Browse Any 2023 Medicare Plan Formulary (or Drug List), Q1Rx Drug-Finder: Compare Drug Cost Across all 2023 Medicare Plans, Find Medicare plans covering your prescriptions. Please check the plans formulary for specific drugs covered. Enrollment in plans depends on contract renewal. 'https:' : 'http:') + (function() { also provides the following benefits. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. All plan-related information on this site is from www.cms.gov and www.medicare.gov. Martins Point Generations Advantage Prime (HMO-POS) For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. After the total drug costs paid by you and the plan reach $4,660, up to the out-of-pocket threshold of $6,350. Martin's Point Generations Advantage, Inc. NAIC Group Code 0000 0000 NAIC Company Code 15850 Employer's ID Number 47-4682941 (Current) (Prior) . Plan Type Medicare Advantage (Part C) Medicare Advantage combines Part A and Part B. Details drug coverage for Martin's Point Generations Advantage Martin's Point Generations Advantage Value Plus (HMO) in New Hampshire. 2023 Medicare Advantage Plan Benefits explained in plain text. We do not offer every plan available in your area. We are not compensated for Medicare plan enrollments. Any information we provide is limited to those plans we do offer in your area. Below are Brenda's credentials for the Military-focused seminars. Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition. Our. Your Part B premium may differ based on factors including late enrollment, income, and disability status. We'll process your request and get a check out to you within 4-6 weeks. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. Martins Point Generations Advantage Flex (Regional PPO) Martin's Point Generations Advantage Medicare Advantage Plans with Part D Medicare Health Speak to a Licensed Insurance Agent 833-835-0205 Mon - Fri 7 a.m. - 10 p.m. Martins Point Generations Advantage Prime (HMO-POS) In-Network: Yes, contact plan for further details Inpatient hospital coverage $425 per day for days 1 through 5 / $0 per day for days 6 through 90 Outpatient hospital coverage $0-275 copay per. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227. Check-in point. Medicare has neither approved nor endorsed any information on this site. Rapid application development was a response to plan-driven waterfall processes, developed in the 1970s and 1980s, such as the Structured Systems Analysis and Design Method (SSADM). Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Every year, Medicare evaluates plans based on a 5-star rating system. Sessions last about one hour. The Martin's Point Generations Advantage Alliance (HMO) (H5591 - 003) currently has 5,533 members. RH APP. The plan deposits The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Star Ratings are calculated each year and may change from one year to the next. Live chat. There are 389 members enrolled in this plan in York, Maine, and 4,302 members in Maine. Bouvet Springs, Inc. 359 Current Problem Products and Pricing 30. We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. Why?Would you recommend a management change? All rights reserved | About | Contact | Legal and Privacy, Martins Point Generations Advantage Flex (Regional PPO). Martin's Point Generations Advantage Alliance (HMO) Medicare Plan Details (2022 Plan) Monthly Premium by Martin's Point Generations Advantage Additional Coverage HearingVisionDental Overall Government Star Rating 5.0 out of 5 stars Ready to Enroll Online? var s = document.getElementsByTagName('script')[0]; ET, Sat - Sun 10. Enrollment in a Martin's Point. Benefits may vary by carrier and location. On the underground movement of (pirated) theory text sharing 2009 # Scanners, collectors and aggregators. Get free advice and help from a licensed insurance agent to enroll in the plan of your choice. According to the latest data, about 68% of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2022, up from 49% in 2021. This page features plan details for 2022 Martins Point Generations Advantage Flex (Regional PPO) $10.35 copay or 5% (whichever costs more), Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). Although you pay no additional monthly premium and receive a Part B premium rebate of $50. Martin's Point Generations Advantage Prime (HMO-POS) is a Medicare Advantage (Part C) Plan by Martin's Point Generations Advantage. Over-the-counter drug benefits: Some coverage, Meals for short duration: Some coverage, WorldWide emergency transportation: Some coverage, WorldWide emergency coverage: Some coverage, WorldWide emergency urgent care: Some coverage, Personal Emergency Response System (PERS): Some coverage, Medical Nutrition Therapy (MNT): Some coverage. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. Members may enroll in a Medicare Advantage plan only during specific times of the year. var gcse = document.createElement('script'); Call 1-877-354-4611 TTY 711, In-Network: Yes, contact plan for further details, In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required), Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required), Covered under office visit (limits may apply), Out-of-Network: $50 copay or 50-75% coinsurance, In-Network: 20% coinsurance (authorization required), Out-of-Network: 20% coinsurance (authorization required), In-Network: $0-5 copay or 0-20% coinsurance (authorization required), Out-of-Network: 30% coinsurance per visit, In-Network: $0 copay (limits may apply) (referral required), Out-of-Network: 30% coinsurance (limits may apply) (referral required), In-Network: $495-2,095 copay (limits may apply), Out-of-Network: $495-2,095 copay (limits may apply), In-Network: $45 copay (referral required), Out-of-Network: 30% coinsurance (referral required), In-Network: $395 per day for days 1 through 5, Out-of-Network: 30% per stay (authorization required), In-Network: $0-350 copay per visit (authorization required), Out-of-Network: 30% coinsurance per visit (authorization required), In-Network: $230 per day for days 1 through 7, In-Network: $0 per day for days 1 through 20, Out-of-Network: 30% coinsurance (limits may apply). Martin's Point Generations Advantage Medicare Advantage Plans Medicare Health Speak to a Licensed Insurance Agent 833-835-0205 Mon-Fri 8am-8pm ET | TTY/TDD #711 Shop Online for Plan. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult. Join us for a free Medicare Seminar and Q&A session about combining your military health benefits with a Generations Advantage Plan for the best coverage and savings. Every year, Medicare evaluates plans based on a 5-star rating system. Get free advice and help from a licensed insurance agent to enroll in the plan of your choice. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Medicare has neither approved nor endorsed any information on this site. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Contact the Medicare plan for more information. Not affiliated with or endorsed by any government agency. RADISSON MEETINGS. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Save up to 10% and enjoy exclusive benefits as a Radisson Rewards member. ET, Sat Sun 10a.m. 7p.m. We do not feature every plan available in your area. Martin's Point Plans Receive Five Star Rating for 2023. MA-Compare: Review Changes in each 2022 Medicare Advantage Plan for 2023, Find a 2023 Medicare Part D Plan (PDP-Finder: Rx Only), Browse Any 2023 Medicare Plan Formulary (Drug List), Q1Rx 2023 Medicare Part D or Medicare Advantage Plan Finder by Drug, Guided Help Finding a 2023 Medicare Prescription Drug Plan, Search for 2023 Medicare Plans by Plan ID, Search for 2023 Medicare Plans by Formulary ID, 2023 Medicare Prescription Drug Plan (PDP) Benefit Details, 2023 Medicare Advantage Plan Benefit Details, Medicare plan quality and CMS Star Ratings, Understanding Your Explanation of Benefits, IRMAA: Higher premiums for higher incomes, 2023 Medicare Advantage Plans State Overview, Find a 2023 Medicare Advantage Plan by Drug Costs. Generations Advantage plans offer extra benefits that fit your needs and save you money. Sessions last about one hour. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. 20 year Veteran Army Officer. ? Any information we provide is limited to those plans we do feature. '//cse.google.com/cse.js?cx=' + cx; This page features plan details for 2023 Martins Point Generations Advantage Prime (HMO-POS) Then, answer the following questions: Would you approve the addition of unlabeled water? var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; How this plan performs in coverage of conditions, screenings, customer service and more. Overview Medicare Advantage Medicare Advantage Update for Providers Who Opted Out of Medicare January 1, 2022 Until recently, providers who opted out of Medicare could not be paid by Northeast Delta Dental for dental services provided to a Martin's Point Generations Advantage (MPGA) patient. Please contactwww.medicare.govor1-800-MEDICARE(TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information about Medicare plan options. Join us at a FREE seminar to learn about Medicare and how our Generations Advantage plans offer the coverage you need and the extra benefits you want! After you pay your $275.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4430.00. Generation Advantage Updates and Articles. We do not directly sell health insurance or offer professional legal, medical, or financial advice. Any information we provide is limited to those plans we do feature. Martins Point Generations Advantage Flex (Regional PPO) These are: Generations Advantage Prime (HMO POS) 2021 Generations Advantage. Aggregate write-ins for other liabilities (including $ current) 0 0 0 0 LoginAsk is here to help you access Martin's Point Cvs Login quickly and handle each specific case you encounter. gcse.src = (document.location.protocol == 'https:' ? Roughly 90% of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2022. Not all plans offer all of these benefits. Search our 2023 Formulary Your benefits just keep getting better! Bouvet Springs, Inc. We do not offer every plan available in your area. After your total drug costs (including what this plan has paid and what you have paid) reach $4430.00, you will pay no more than the amounts below for any drug tier until you reach $7050.00. Limitations and exclusions may apply. Description Bouvet Springs Read the case titled Bouvet Springs in A Casebook on Corporate Renewal. offers the following coverage and cost-sharing. provides the following cost-sharing on drugs. Not all plans offer all of these benefits. Enrollment in plans depends on contract renewal. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. We only use data released publicly each year. A 5-star rating is the highest rating possible from Medicare. Not affiliated with or endorsed by any government agency. Martin's Point Generations Advantage Maine Medicare Advantage Plans Medicare Health Speak to a Licensed Insurance Agent 888-245-4280 Mon-Fri 7am-10pm, Sat 10am-7pm ET | TTY/TDD #711. See the Part D Premium Reduction section below for more details. For your convenience, we offer group and individual seminars, both in person and online. Get the monthly weather forecast for Wernsbach bei Windsbach, Bavaria, Germany, including daily high/low, historical averages, to help you plan ahead. The Martin's Point Generations Advantage Alliance (HMO) offers many Health Coverage Benefits. All insurance agents and enrollment platforms linked to this site have their own terms and conditions. We do not sell leads or share your personal information. Your Part B premium may differ based on factors including late enrollment, income, and disability status. 381 views, 17 likes, 0 loves, 0 comments, 11 shares, Facebook Watch Videos from Fischerov Chess Page: IM Alex Banzea's London System Buy the full course. Compare all Medicare Supplement Insurance Plans (Medigap) plans offered by Martin's Point Generations Advantage in Maine, Oxford County. For more information contact the plan. Earn 3,000 bonus points for your first booking in our app. Radisson Meetings. Medicare Advantage Plus Prescription Drug, Aroostook, Franklin, Hancock, Knox, Penobscot, Washington, Lincoln, Oxford, Piscataquis, Somerset, Waldo, Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Best Continuing Care Retirement Community (CCRC), Best Medicare Advantage Plan Companies 2023, whether Medicare Advantage is right for you, What to Consider When Shopping for Medicare Coverage, Find Continuing Care Retirement Communites, California Do Not Sell My Personal Information Request. s.parentNode.insertBefore(gcse, s); Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Wellness Wallet Reimbursement Form 2023 Wellness Wallet Reimbursement Form (PDF) Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Contact the plan provider for additional information. H5591 006 2 available in Kennebec & Sagadahoc Counties. We are an independent education, research, and technology company. PDP-Compare: How will each 2022 Part D Plan Change in 2023? Martins Point Generations Advantage Flex (Regional PPO) First time's a charm. The $275.00 annual deductible only applies to drugs on certain tiers. ? After you pay your deductible, if applicable, up to the initial coverage limit of $4,660. You may also qualify for Extra Help on drug costs. Please check the plans formulary for specific drugs covered. Get free advice and help from a licensed insurance agent to enroll in the plan of your choice. Martin's Point Generations Advantage Flex (Regional PPO) is a Medicare Advantage (Part C) Plan by Martin's Point Generations Advantage. offers the following coverage and cost-sharing. Call 1-877-354-4611 TTY 711, $10.35 copay or 5% (whichever costs more), In-Network: Yes, contact plan for further details, In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required), In-Network: 20% coinsurance (authorization required) (referral required), Out-of-Network: 30% coinsurance (authorization required) (referral required), In-Network: 0-15% coinsurance (authorization required) (referral required), In-Network: $0-5 copay or 0-20% coinsurance (authorization required) (referral required), In-Network: 15% coinsurance (authorization required) (referral required), In-Network: $40 copay per visit (authorization not required) (referral required), Out-of-Network: $55 copay per visit (authorization not required) (referral required), In-Network: $0 copay (authorization not required), Out-of-Network: 20% coinsurance per item (authorization not required), In-Network: 20% coinsurance per item (authorization required), Out-of-Network: 30% coinsurance per item (authorization required), In-Network: $40 copay (authorization not required) (referral required), Out-of-Network: $55 copay (authorization not required) (referral required), In-Network: $0 copay (limits may apply) (authorization not required) (referral required), In-Network: $495-2,095 copay (limits may apply) (authorization not required) (referral not required), In-Network: $375 per day for days 1 through 5, Out-of-Network: 40% per day for days 1 through 100 (authorization required) (referral not required), In-Network: 20% coinsurance (authorization required), In-Network: $220 per day for days 1 through 7, Out-of-Network: Not Applicable (authorization required) (referral not required), In-Network: $25 copay (authorization required) (referral not required), Out-of-Network: $30 copay (authorization required) (referral not required), In-Network: $0-275 copay per visit (authorization required) (referral not required), Out-of-Network: $400 copay per visit (authorization required) (referral not required), In-Network: $0 copay (authorization not required) (referral not required), Covered under office visit (limits may apply) (authorization not required) (referral not required), In-Network: $50.00 (authorization not required) (referral not required), In-Network: $0 per day for days 1 through 20, In-Network: $0 copay (limits may apply) (authorization not required) (referral not required), Covered (authorization not required) (referral not required).
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