Trinity Health Plan of Michigan No Premium (HMO)

Inpatient Hospital See details

Inpatient Hospital services are covered by Trinity Health Plan of Michigan No Premium (HMO), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $300 copay for days 1-6, and no copay for days 7-90, while Additional Days are unlimited and have no copay. Inpatient Hospital Psychiatric has the same cost-sharing structure as Inpatient Hospital-Acute.

Outpatient Services See details

Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $250, observation services with no copay, ambulatory surgical center services with a $250 copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered under the Trinity Health Plan of Michigan No Premium (HMO) plan with a $55 copay.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, and air ambulance services have a $300 copay, but there is no coinsurance for either. Transportation services to health-related locations are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Trinity Health Plan of Michigan No Premium (HMO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and no coinsurance, and Worldwide Emergency Transportation has a $250-$300 copay and no coinsurance.

Primary Care See details

The Trinity Health Plan of Michigan No Premium (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $10 copay, while occupational therapy services have a $20 copay.

Physician specialist services have a $30 copay, and physical therapy and speech-language pathology services have a $20 copay.

Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions.

Additional telehealth benefits have a copay between $0 and $30.

Routine Chiropractic Care and Podiatry Services are not covered.

Preventive Services See details

Preventive Services include an annual physical exam with no copay, while other services, such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS), are not covered. Additional preventive services and services like Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have no copay.

Hearing Services See details

Hearing exams have a $30 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $599 and $899, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.

Vision Services See details

Vision Services includes eye exams with a copay of $0-$30, and eyewear with no copay, with a combined maximum benefit of $225 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, while upgrades are not covered.

Dental Services See details

The Trinity Health Plan of Michigan No Premium (HMO) plan covers dental services, including Medicare Dental Services with a $30 copay, and Other Dental Services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, Endodontics and Periodontics have a 70% coinsurance, and other services have no coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0-20%.

Dialysis Services See details

Dialysis Services are covered under the Trinity Health Plan of Michigan No Premium (HMO) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost sharing. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by the Trinity Health Plan of Michigan No Premium (HMO) plan. Diagnostic Procedures/Tests have a $30 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $20 copay.

Home Health Services See details

Home Health Services are covered by the Trinity Health Plan of Michigan No Premium (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Trinity Health Plan of Michigan No Premium (HMO). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Trinity Health Plan of Michigan No Premium (HMO) plan. For days 1-20, there is no copay, for days 21-55, the copay is $214, and for days 56-100, there is no copay.

Other Services See details

Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $20 copay and is limited to 12 treatments per year, while OTC items have no copay and a maximum benefit coverage amount of $115 every three months. The meal benefit has no copay.