Prominence Veteran (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $330 copay for days 1-5, and no copay for days 6-60. Additional days and non-Medicare covered stays for both are not covered.

Outpatient Services See details

Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $25.00 - $350.00, observation services have a copay of $295.00 per stay, and ambulatory surgical center services have a copay of $25.00. Individual and group sessions for outpatient substance abuse have a copay of $10.00.

Partial Hospitalization See details

Partial Hospitalization is covered by the Prominence Veteran (HMO) plan, but requires prior authorization. You will have a $55 copay for this service.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $300 copay, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Any health-related location transportation is not covered.

Emergency Services See details

Emergency Services are covered under the Prominence Veteran (HMO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $30 copay and no coinsurance, while Worldwide Emergency Coverage has a $125 copay and no coinsurance. Worldwide Urgent Coverage has a $30 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.

Primary Care See details

Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services with a $10 copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $10 copay for individual and group sessions, Podiatry Services with a $5-$20 copay, Other Health Care Professional services with a $0-$45 copay, Psychiatric Services with a $10 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a $10 copay. Routine Chiropractic Care has a $20 copay for up to 12 visits per year.

Preventive Services See details

The Prominence Veteran (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services include In-Home Safety Assessment, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.

Hearing Services See details

Hearing Services include routine hearing exams with a $10 copay and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to a maximum of $600 per year, with copays between $0 and $1725. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

Vision services include eye exams, with a $30 copay, and eyewear coverage. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 per year.

Dental Services See details

The Prominence Veteran (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, implant services, prosthodontics, fixed, and oral and maxillofacial surgery. Restorative services, prosthodontics, fixed, and oral and maxillofacial surgery have a copay of $50-$100, adjunctive general services have a copay of $0-$50, and endodontics has a copay of $100. Maxillofacial prosthetics and orthodontics are not covered, and implant services are offered as an optional, supplemental benefit.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the Prominence Veteran (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Prominence Veteran (HMO) plan, but require prior authorization. You will pay 20% coinsurance for this service.

Medical Equipment See details

Medical Equipment is covered under the Prominence Veteran (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.

Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance for Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies.

Diabetic Equipment has a coinsurance for Medicare-covered Diabetic Supplies, and Diabetic Supplies are not covered.

Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by the Prominence Veteran (HMO) plan, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $60, and Therapeutic Radiological Services have a coinsurance of at most 20%.

Home Health Services See details

Home Health Services are covered by the Prominence Veteran (HMO) plan with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered under the Prominence Veteran (HMO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Prior authorization is required for this benefit.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Prominence Veteran (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.

Other Services See details

Other Services in the Prominence Veteran (HMO) plan include a meal benefit with prior authorization, while acupuncture, over-the-counter items, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.