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Coverage for Your Smile

It’s important to protect your teeth and gums with routine dental care. We partner with Say Cheese Dental Network 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 allowed amount out-of-network 

You can contact Say Cheese Dental Network customer service toll free at 888-454-4127 (TTY 711), Monday-Friday from 7 a.m. to 10 p.m. and Saturday from 8 a.m. to 5:30 p.m.

Visit Say Cheese Dental Network's website to Find a Dental Provider.

Please use this form to request an out-of-network reimbursement.


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 of this brochure) 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 10 p.m. and Sunday from 10 a.m. to 7 p.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 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 One Pass™

One Pass membership is included in your Medicare Advantage Plan.

Don’t worry if you’re new to fitness. No matter what your fitness level and ability, you will find the support you need.

The day your benefits start, you can set up your online account by visiting youronepass.com, clicking Get Started and following the prompts to enter your information.

On-Demand Fitness and Wellness Classes

  • Unlimited access to 15,000+ on-demand audio and video workout and wellness classes across multiple categories

  • Multi-week goal-based programs and challenges

  • New classes and programs added weekly

  • Works with smart devices and smart TVs

Network Health’s One Pass membership gives you access to more than 15,000 virtual fitness programs and over 26,000 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 YourOnePass.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.

  1. 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.

  2. Text NETWORK to 635483 to be walked through step-by-step registration on your phone.

  3. Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.

  4. 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 $225, 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, along with your member guide. 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.comView the catalog for additional information and use the order form to place your order. 


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, 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. To maximize your benefit, 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

Network Health offers you access to a network of friendly helpers that provide you support with daily activities such as household tasks, technology help, transportation, shopping, meal preparation and more. You receive 60 hours of in-home support services per year. To maximize your benefit, members can call their care manager to enroll at 866-709-0019 (TTY 947-3529), Monday-Friday from 8 a.m. to 5 p.m.


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 appointments1. 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 care manager directly to make arrangements. View pages six and seven of this brochure for additional information.


Acupuncture1

A maximum of 12 visits per year are covered for members who are undergoing chemotherapy and have severe nausea and/or vomiting.


Health Risk Assessment Reward

Our Network Health Cares members earn one $50 reward, per year, when you complete a health risk assessment (HRA). You can contact your care manager or visit your member portal at login.networkhealth.com to complete your HRA.  


Part B Premium Giveback

If you pay a Medicare Part B premium, we may pay part of that monthly premium for you. We call this a Part B premium giveback, and it is included with the Network Health Cares plan. It’s like getting a raise on your Social Security check.

To qualify for the monthly $2.50 Part B premium giveback, you must be enrolled in Medicare Parts A and B, pay your own premiums and live in a service area that offers the Part B giveback.

The giveback is administered through the Social Security Administration, and depending on how you pay the Part B premium, the giveback can take up to 90 days to begin and will show as an increase in your Social Security check or a credit on your Part B premium statement.





1This is a Special Supplemental Benefit for the Chronically Ill (SSBCI) benefit. In addition to an eligible chronic condition, members must also meet additional eligibility requirements to receive the SSBCI benefit.

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.