MODEL 108: SPOUSES ELIGIBLE FOR MEDICARE
(Secondary to Medicare)
Plan payment may not exceed Usual, Customary and Reasonable (UCR) charges
Plan 10
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 PAYSColostomy 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
Inpatient Care 100% of Medicare eligible expenses for up to 365 additional days after lifetime reserve days have been used
Pap Smears 100%
PSA Tests 100%
Preventive Care (routine physicals, immunizations, etc.) 100%
Not Covered
(1) Prescription drugs
(2) Chiropractic care unless covered by Medicare
(3) Podiatric care unless covered by Medicare
(4) Hearing aids