MMM Elite Ultra (HMO POS) - 2017 ImprimirPrint

The MMM Elite Ultra plan features a list of benefits with low copayments and $0 premium, with no deductibles. This plan also covers all Medicare-covered preventive services with zero cost sharing.

 

 

What do we offer?

Medical visits and Hospital stays

$0copay

Primary Care Physician (PCP)

  • $7copay

    Preferred Network Specialists

  • $13copay

    General Network Specialists

  • $12copay

    Psychiatrist or mental health specialists

  • $10copay medicare covered visits

    Chiropractic

  • $75copay per admission

    Preferred Network Hospital stay

  • $75copay

    Emergency care, $100 in worldwide coverage

Drug Coverage*

$2copay

Preferred Generic Drugs

  • $7copay

    Generic Drugs

  • $35copay

    Preferred Brand Drugs

  • $65copay

    Non Preferred Drugs

  • 33%coinsurance

    Specialty Drugs

More Benefits

$15copay

Preventive dental services

  • $500Up to $500 a year

    Removable Prosthodontics

  • 0%coinsurance

    Diabetic supplies

  • $0One pair a year

    Eyeglasses or contact lenses

  • $200every three years

    Hearing aids

  • 20%coinsurance

    Out-of-Network Coverage*

 

*Out-of-Network Coverage covers up to $ 5,000 per year and requires preauthorization. In the Drug Coverage, while you are in the Coverage Gap, you will pay 40% of the cost for brand name drugs (plus dispensing fee), through the Medicare Gap Coverage Discount Program, and generally pay no more than 51% of the cost for generic drugs. This plan offers additional coverage in the gap for some drugs.

 

Do you need a printed copy of any of these documents? We can send it by mail, request it here.