Dean Advantage plan options and details

All plans include:

$
0
additional benefits
  • Dental

    We cover both preventive and comprehensive dental benefits through our partner Delta Dental. Our plan has no waiting period, no deductibles or coinsurance.

    • Preventive and diagnostic services: $0 copay.
    • Gum disease maintenance and bridge/implants/ dentures repairs: $45 copay.
    • Fillings, non-surgical gum disease treatment and extractions: $95 copay.
    • Root canals, bridges, implants, dentures, crowns and surgical gum disease treatment: $595 copay.
    • We cover $1,500 in dental services per year.

    Search our Delta Dental network of dentists.

  • In-home support from Papa
    We partnered with Papa, a company that connects you with screened and trained Papa Pals who provide assistance with organization, light housework, technology and transportation. Your Pal can visit with you in your home or virtually for up to 10 hours per month.
  • Over-the-counter

    We cover $50 per quarter to spend on eligible over-the-counter products like bandages, pain relievers and much more. You can shop:

    • In-store at participating retailers including Walgreens, CVS, Walmart, Dollar General and Kroger stores.
    • Online at OTCNetwork.com.
    • Mail-order catalog.
  • Hearing
    We cover one $0 routine hearing exam and a $750 hearing aid allowance per year at in-network hearing aid providers.
  • Vision
    We cover one $0 routine vision exam and a $200 eyewear allowance per year at in-network eyeglass providers.
  • Lyft transportation
    We partnered with Lyft to cover 24 one-way personal rides each year to medical appointments and to the pharmacy.
  • Post-discharge meals
    We cover 14 meals from Mom's Meals delivered to your door after you are discharged from the hospital or a skilled nursing facility.
  • Silver&Fit fitness

    The Silver&Fit® program includes:

    • Fitness center memberships.
    • Home fitness kit with a Fitbit, Garmin or other exercise equipment.
    • 8,000+ on-demand videos.
  • Chiropractic care / Acupuncture
    We cover additional chiropractic and acupuncture benefits to help you stay healthy and active.
  • 24-hour nurse line
    Experienced registered nurses are always available to answer your questions and concerns. Nurses are available 24 hours a day, 365 days a year. Call if you're unsure if you need to see a doctor, or if you have other health related questions.
  • Living Healthy rewards
    You can earn up to $150 in rewards for completing healthy activities like receiving a flu shot, going to the dentist and getting an annual physical.

2022 Benefit Overview

Essential (HMO)

$
0
per month
  • Part B premium reduction
    N/A
  • Hospital copay
    $350/day for days 1-5
  • Primary care copay
    $0
  • Specialist copay
    $50
  • Emergency room copay
    $50
  • Urgent care copay
    $50
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    $40
  • Durable medical equipment
    20%
  • Outpatient surgery
    $300
  • Maximum out-of-pocket (per year)
    $6,500

Assurance (HMO-POS)

$
40
per month
  • Part B premium reduction
    N/A
  • Hospital copay
    In-network: $350/day for days 1-5
    Out-of-network: $500/day for days 1-7
  • Primary care copay
    In-network: $0
    Out-of-network: $60
  • Specialist copay
    In-network: $40
    Out-of-network: $60
  • Emergency room copay
    $90
  • Urgent care copay
    $40
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40
    Out-of-network: $60
  • Durable medical equipment
    In-network: 20%
    Out-of-network: 40%
  • Outpatient surgery
    In-network: $300
    Out-of-network: 20% coinsurance
  • Maximum out-of-pocket (per year)
    $4,500

SSM Presence* (HMO-POS)

$
0
per month
  • Part B premium reduction
    N/A
  • Hospital copay
    In-Network: $350/day for days 1-5
    Out-of-network: $500/day for days 1-7
  • Primary care copay
    In-network: $0
    Out-of-network: $60
  • Specialist copay
    In-network: $40
    Out-of-network: $60
  • Emergency room copay
    $90
  • Urgent care copay
    $40
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40
    Out-of-network: $60
  • Durable medical equipment
    In-network: 20%
    Out-of-network: 40%
  • Outpatient surgery
    In-network: $300
    Out-of-network: 20% coinsurance
  • Maximum out-of-pocket (per year)
    $4,500

Balance (HMO-POS)

$
82
per month
  • Part B premium reduction
    N/A
  • Hospital copay
    In-Network: $350/day for days 1-5
    Out-of-network: $500/day for days 1-7
  • Primary care copay
    In-network: $0
    Out-of-network: $50
  • Specialist copay
    In-network: $25
    Out-of-network: $50
  • Emergency room copay
    $90
  • Urgent care copay
    $25
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $25
    Out-of-network: $60
  • Durable medical equipment
    In-network: 20%
    Out-of-network: 40%
  • Outpatient surgery
    In-network: $300
    Out-of-network: 20% coinsurance
  • Maximum out-of-pocket (per year)
    $3,500

Complete (HMO)

$
251
per month
  • Part B premium reduction
    N/A
  • Hospital copay
    $350/day for days 1-5
  • Primary care copay
    $0
  • Specialist copay
    $10
  • Emergency room copay
    $120
  • Urgent care copay
    $10
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    $10
  • Durable medical equipment
    20%
  • Outpatient surgery
    $300
  • Maximum out-of-pocket (per year)
    $2,000

Harmony (HMO-POS MA-only)

$
0
per month
  • Part B premium reduction
    $20 Monthly Part B premium reduction
  • Hospital copay
    In-Network: $350/day for days 1-5
    Out-of-network: $500/day for days 1-7
  • Primary care copay
    In-network: $0
    Out-of-network: $75
  • Specialist copay
    In-network: $35
    Out-of-network: $75
  • Emergency room copay
    $90
  • Urgent care copay
    $35
  • Ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $35
    Out-of-network: $75
  • Durable medical equipment
    In-network: 20%
    Out-of-network: 40%
  • Outpatient surgery
    In-network: $300
    Out-of-network: 20% coinsurance
  • Maximum out-of-pocket (per year)
    $4,500

2022 Part D Drug Overview

Essential (HMO)

$
250
Stage 1 - initial coverage deductible (applies to Tiers 3-5)
  • Stage 2 - initial coverage copay and coinsurance you pay:

     


      1 month/30 day 3 month/90 day
      Preferred retail and mail order Standard retail Preferred retail and mail order Standard retail
    Tier 1 $0 $7 $0 $7
    Tier 2 $5 $12 $10 $24
    Tier 3 $40 $47 $100 $117.50
    Tier 4 $90 $100 $270 $300
    Tier 5 28% Not applicable
  • Stage 3 - coverage gap (donut hole) you pay:
    25% coinsurance
  • Stage 4 - catastrophic coverage you pay:
    Generic: 5% or $3.95
    Brand: 5% or $9.85

Assurance | SSM Presence* (HMO POS)

$
150
Stage 1 - initial coverage deductible (applies to Tiers 3-5)
  • Stage 2 - initial coverage copay and coinsurance you pay:

     


      1 month/30 day 3 month/90 day
      Preferred retail and mail order Standard retail Preferred retail and mail order Standard retail
    Tier 1 $0 $7 $0 $7
    Tier 2 $5 $12 $10 $24
    Tier 3 $40 $47 $100 $117.50
    Tier 4 $90 $100 $270 $300
    Tier 5 30% Not applicable
  • Stage 3 - coverage gap (donut hole) you pay:
    25% coinsurance
  • Stage 4 - catastrophic coverage you pay:
    Generic: 5% or $3.95
    Brand: 5% or $9.85

Balance (HMO POS)

$
100
Stage 1 - initial coverage deductible (applies to Tiers 3-5)
  • Stage 2 - initial coverage copay and coinsurance you pay:

     


      1 month/30 day 3 month/90 day
      Preferred retail and mail order Standard retail Preferred retail and mail order Standard retail
    Tier 1 $0 $7 $0 $7
    Tier 2 $5 $12 $10 $24
    Tier 3 $40 $47 $100 $117.50
    Tier 4 $90 $100 $270 $300
    Tier 5 31% Not applicable
  • Stage 3 - coverage gap (donut hole) you pay:
    25% coinsurance
  • Stage 4 - catastrophic coverage you pay:
    Generic: 5% or $3.95
    Brand: 5% or $9.85

Complete (HMO)

$
0
Stage 1 - initial coverage deductible (applies to Tiers 3-5)
  • Stage 2 - initial coverage copay and coinsurance you pay:

     


      1 month/30 day 3 month/90 day
      Preferred retail and mail order Standard retail Preferred retail and mail order Standard retail
    Tier 1 $0 $7 $0 $7
    Tier 2 $5 $12 $10 $24
    Tier 3 $40 $47 $100 $117.50
    Tier 4 $90 $100 $270 $300
    Tier 5 33% Not applicable
  • Stage 3 - coverage gap (donut hole) you pay:
    25% coinsurance
  • Stage 4 - catastrophic coverage you pay:
    Generic: 5% or $3.95
    Brand: 5% or $9.85