MODEL 107: RETIREES ELIGIBLE FOR MEDICARE
(Secondary to Medicare)
Plan payments may not exceed Usual, Customary and Reasonable (UCR) charges
Plan 9
The Association pays the deductible and/or coinsurance on any charges approved by Medicare. The Association will also pay the difference between the billed amount and the Medicare approved amount on Non-Assigned claims. Claims submitted must include a copy of the itemized charges including the diagnosis, as well as a copy of the Explanation of Medicare Benefits showing how much Medicare approved and paid on each charge.In addition, the Association provides the following benefits, whether or not they are covered by Medicare.
BENEFIT * WABASH PAYS
Chiropractic Care 80% to a maximum of $600.00 per calendar yearColostomy Bags (Only) 50% reimbursement
Dietary Consultation up to $50.00 once per year
Eye Exam one exam per year at 100% up to a maximum of $40.00
Hearing Aids (hearing loss must be greater than 35dB) 80% to a maximum of $300.00 per item (renewable after five years)
Inpatient Hospital Charges 100% of Medicare eligible expenses for up to 365 additional days after lifetime reserve days have been used
Pap Smears 100%
Prescriptions Drugs
Gen. $2 retail 30 days
$4 M.O. 90 days
Brand $15 retail 30 days*
$30 M.O. 90 days*
$750 total annual benefit
Call EHO (1-800-650-9161) For additional details
*(or the greater of 20%)
PSA Tests 100%
Preventive Care (routine physicals, immunizations, etc.) 100%