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2024 Extra Benefits for Network Health Cares (PPO D-SNP)
Coverage for Your Smile
It’s important to protect your teeth and gums with routine dental care. We partner with Delta Dental Medicare Advantage providers to offer you preventive and comprehensive dental care. View pages two and three of this brochure for additional information.
| Dental Care Services $3,000 Annual Maximum |
Member Cost |
| $0 Cleaning (twice a year) |
$0 copayment |
|
$0 Dental X-ray(s) Bitewing X-ray, one per year Full mouth X-ray, one every five years |
$0 copayment |
| $0 Oral exam (twice a year) | $0 copayment |
| $0 Basic restorative services | $0 copayment |
| $0 Major services received at in-network providers (endodontics/periodontics/extractions/prosthodontics, other oral/maxillofacial surgery) | 50% of the cost if out-of-network |
You can contact Delta Dental® Medicare Advantage at 866-548-0292 (TTY 711), Monday–Friday from 7 a.m. to 7 p.m.
Visit Delta Dental's website to Find a Dental Provider.
Protecting Your Vision for the Future
Network Health Cares members have access to a $0 annual routine eye exam at a participating EyeMed® provider. Simply show your Network Health ID card to your EyeMed provider at the time of your exam. The provider will take care of the rest.
You’ll also get up to $400 (in-network allowance, out-of-network reimbursement) annually for contact lenses and/or glasses with a valid prescription when you visit an EyeMed provider.
Here are some additional benefits (see pages four and five) available to you with EyeMed through your Network Health Cares plan.
You can contact EyeMed at 833-279-4359 (TTY 711), Monday–Saturday from 7 a.m. to 1 a.m. and Sunday from 10 a.m. to 7 p.m. Sunday hours from October 1 - March 31 are 7 a.m. to 1 a.m.
Visit EyeMed's website to Find a Vision Provider.
Please use this claim form to request an out-of-network reimbursement. To request reimbursement for your out-of-network services using your in-network benefits use this exception form.
Hearing
Hearing impacts your health, wellness and safety. We know how important that is, which is why we partner with TruHearing® to offer you a hearing benefit, so you can enjoy the world around you.
Your hearing benefit includes an annual routine hearing exam at a local TruHearing provider for $0 if you see an in-network provider or $40 if you see an out-of-network provider. Use this form (COMING SOON) to submit an out-of-network reimbursement.
You also have access to select high-quality hearing aids, hearing aid fittings and follow-up care for $495-$1,695 per device when purchased through TruHearing. View page three of this brochure for additional information.
We recommend checking your Medicaid hearing benefit prior to using this benefit. Medicaid may cover a hearing exam and hearing aids for you.
To find a provider and schedule an appointment, contact TruHearing at 877-759-8131 (TTY 711), Monday-Friday from 8 a.m. to 8 p.m.
Fitness Benefit with SilverSneakers®
SilverSneakers membership is included in your Medicare Advantage Plan.
Don’t worry if you’re new to fitness—nearly half of SilverSneakers members have never been to a gym before joining. No matter what your fitness level and ability, you will find the support you need.
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Ready to socialize? Join a group class like yoga or SilverSneakers Classic.
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Rather exercise on your own? You’ll have full access to all facility fitness equipment.
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Prefer to get wet? Hit the facility fitness pool.
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Looking for something different? Discover FLEX® classes, taking workouts beyond the gym.
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Enjoy the pool at one location and the stability class at another? Your membership grants you access to multiple facilities, so you can participate in both classes.
Network Health’s SilverSneakers membership gives you access to virtual fitness programs and over 16,000 nationwide locations, so if you’re traveling it’s easy to find a convenient location near you. You can enroll in as many locations as you like, at any time. Visit SilverSneakers.com today for more information.
MDLIVE® Virtual Visits
Virtual visits, brought to you through MDLIVE, are a great way to save time and money when you experience non-emergency symptoms. By using your phone, smartphone, tablet or computer, you can connect with a board-certified physician for treatment of a wide range of conditions—24 hours a day, seven days a week.
Network Health Cares members have access to MDLIVE virtual visits for $0 per visit.
Register for MDLIVE today, so your account is ready when you need it. You can also get prescriptions filled, if needed. Online doctor visits through MDLIVE are a convenient and affordable alternative to urgent care or a doctor visit if your personal doctor isn't available.
Set up your Network Health MDLIVE account in one of four ways.
- Log in to your member portal at login.networkhealth.com and click Virtual Visits. Once you've set up your MDLIVE account, you'll be able to seamlessly access it from your member portal.
- Text NETWORK to 635483 to be walked through step-by-step registration on your phone.
- Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.
- Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account.
MDLIVE can assist with the following conditions and many more.
- Acne
- Allergies
- Cold and flu
- Cough
- Diarrhea
- Ear problems
- Fever
- Nausea and vomiting
- Pink eye
- Rash
- Respiratory problems
- Sore throats
- Urinary problems
Over-the-Counter Benefit
Network Health Cares offers an over-the-counter (OTC) benefit of two orders, up to $175, per quarter. Hundreds of useful OTC items can be shipped directly to your door, even if you’re traveling outside the Network Health service area. Unused benefit amounts will not rollover into the next quarter.
You will receive an OTC product catalog in the mail at the beginning of the plan year. To request another copy of the OTC product catalog, call Network Health Member Experience at 855-653-4363 (TTY 800-947-3529), Monday-Friday from 8 a.m. to 8 p.m. From October 1 to March 31, we're available every day from 8 a.m. to 8 p.m. You may also view the OTC product catalog and place your order online through your member portal at login.networkhealth.com. View the catalog for additional information.
Meal and Food Box Delivery
Recovering after an inpatient stay can be difficult. That’s why Network Health partners with Mom’s Meals to provide Network Health Cares members with 28 delicious meals delivered right to your door after a qualifying hospital observation, inpatient hospital or skilled nursing facility stay. To take advantage of this benefit, contact your care manager directly or the Network Health Care Management Department within seven days of discharge at 866-709-0019 (TTY 800-947-3529), Monday-Friday from 8 a.m. to 5 p.m.
Additionally, new this year, Network Health Cares members that have been diagnosed with diabetes, congestive heart failure or obesity may be eligible to receive fresh produce or pantry boxes for delivery, up to six boxes per calendar year. Contact your care manager to arrange delivery of the food boxes.
View page eight and nine of this brochure for additional information.
In-Home Support
New this year, Network Health has partnered with in-home support services to offer you support with daily activities and more. Members can call their care manager to enroll.
Non-Emergency Transportation
Need a ride to the dentist or to the doctor? We can help. Our partnership with Aryv helps you get where you need to be, safely. The transportation benefit includes 36 one-way trips, to and from approved locations, anywhere within the Network Health service area. Members with end-stage renal disease (ESRD) receive an additional 24 one-way trips to get to and from dialysis appointments. To set up transportation for medical, dental, pharmacy or dialysis appointments, call Aryv at 855-923-1113 (TTY 711) or visit the Aryv website. To schedule all other rides, contact your manager directly to make arrangements. View pages six and seven of this brochure for additional information.
Acupuncture
To help treat side effects such as nausea, a maximum of 12 visits per year are covered for members who are undergoing chemotherapy and experiencing nausea.
Health Risk Assessment Reward
Our Network Health Cares members earn a $50 reward, per year, when you complete a health risk assessment (HRA). The health risk assessment was sent in your member guide. If you need another copy, you can contact your care manager or visit your member portal at login.networkhealth.com.
Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. Please call our member experience number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
