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Hap Senior Plus PPO Option 3

Monthly Premium

$165*

Deductible

$0 Medical/$0 Rx

Max out of pocket

$5,000/ $7,000

Copays (PCP/Specialist)

$10/$35

Dental

$0 preventive - 2 cleanings; 2 exams & a set of bite-wing x-rays; 50% coinsurance for comprehensive services with $3,000 max benefit allowance.

Over-the-counter (OTC) benefit

$75 allowance/quarter and can rollover.

Vision

$0 routine exam. $130 yearly allowance for eyeglasses or contact lenses.

Hearing / Hearing Aids

$0 routine exam. Copays for hearing aids - 1 per ear/per year.

Inpatient Hospital

$225 Days 1-7; $0 Days 8-90

Preventive Care

No copay for services considered preventive.

Outpatient Diagnostic Labs, Procedures, Tests

$0 - $150 depending on service.

Emergency Room / Urgent Care

$90/$55 no limit; worldwide coverage

Physical, Occupational and Speech Therapy

$20 per visit; unlimited
* You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.
HAP Senior Plus (HMO-POS), HAP Medicare MedicalAccess (HMO), HAP Senior Plus Henry Ford Tiered Access (HMO), HAP Medicare Connect (HMO), HAP Medicare Superior (HMO), Henry Ford Select (HMO), HAP Senior Plus (PPO), HAP Medicare Explore (PPO), HAP Medicare Prime (PPO), HAP Member Assist (PPO), HAP Medicare Diabetes and Heart (HMO C-SNP), and HAP CareSource™ MI Coordinated Health (HMO D-SNP) has a contract with Medicare. Enrollment depends on contract renewal.