Covenant Advantage (HMO-POS)
$0 Premiums and NO Deductibles
With Covenant Advantage, there are no additional premiums to pay for prescription drug coverage or extras like dental and vision coverage. There are also no annoying deductibles to meet. Your coverage begins right away.
Complete Coverage With One Plan from One Company
Unlike Original Medicare, Covenant Advantage bundles your medical, hospital and prescription drug coverage together in one comprehensive plan. Additionally, our plans come with a number of valuable extra benefits that will save you time and money.
Important Travel Coverage
Whether you are making a trip out of the state or out of the country, we have you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent care coverage.
Important Financial Protection
Covenant Advantage protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses – important protection not offered by Original Medicare.
Valuable Extra Benefits
Every Covenant Advantage plan comes with important extra benefits for no additional premium including dental, vision, transportation to and from doctor appointments, free memberships to health clubs through the popular SilverSneakers® program, and coverage on over-the-counter products such as non-prescription drugs and health-related items.
$0 Copay on Generic Prescriptions
Save even more money on your prescription drugs when you fill your prescription at preferred pharmacies. Covenant Advantage members can get generic prescriptions for $0 copays and reduced copays on brand-name medications at any participating preferred pharmacy.
Benefits at a Glance:
We’ve Got You Covered From Head to Toe
The following table highlights just some of the many in-network benefits available to you as a valued Covenant Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.
Hospital & Medical Coverage
Your Covenant Advantage plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments for in-network providers.
|Maximum Out-of-Pocket Limit (What’s this?)This means you will never pay more than $3,800 per year for covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or co-insurance.||$3,800 Per Year|
|Annual Medical Deductible||$0 Per Year|
|Preventive Care/Screenings||$0 Copay|
|Primary Care Doctor Visits||$5 Copay|
|Specialty Care Doctor Visits||$30 Copay|
|Urgent Care||$60 Copay|
|Emergency Care||$90 Copay|
|Lab Services||$10 Copay|
|Home Health Care||100% Coverage|
|Chiropractic Services||$20 Copay|
|Inpatient Hospital Care|| $200 Copay Per Day for Days 1-7,|
$0 Per Day for Day 8 and beyond
|Outpatient Surgery at Hospital||$150 Copay|
|Outpatient Surgery at Ambulatory Surgical Center||$100 Copay|
Part D Drug Coverage
This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.
|Covenant Advantage (HMO-POS)|
| Other Network|
|Annual Part D Deductible||$0 Per Year||$0 Per Year|
|Tier 1 – Preferred Generics||$0 Copay||$5 Copay|
|Tier 2 – Generics||$0 Copay||$10 Copay|
|Tier 3 – Preferred Brands||$40 Copay||$45 Copay|
|Tier 4 – Non-Preferred Brands||$90 Copay||$95 Copay|
|Tier 5 – Specialty Drugs||33% Co-insurance||33% Co-insurance|
|Initial Coverage Limit||$4,130 Per Year||$4,130 Per Year|
Part D drug expenses are not covered under the maximum out-of-pocket limit.
Your Covenant Advantage plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.
|Vision Care||$25 Copay for routine eye exam|
$0 Copay for one pair of eyeglass frames or contact lenses (2 six packs)
|Preventive Dental Care||$0 Copay (two visits per calendar year)|
|Comprehensive Dental Care||Not Covered|
|Hearing||$25 Copay for hearing exam|
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
|Over-the-Counter (OTC) Items||$50 per quarter,|
up to 2 orders per quarter; no rollover
|Transportation Assistance||$0 Copay for 20 one-way trips to approved locations per year|
|SilverSneakers Fitness Benefits (What’s this?)Covenant Advantage wants to help you achieve and maintain long-lasting health and wellness. SilverSneaker is a fun, energizing program that helps people with Medicare take greater control of their health by encouraging physical activity and offering social events…and it includes a fitness center membership to any participating location across the country at no extra cost to you!||Included at no additional cost|
|Travel Coverage||Emergency or urgent care coverage if you are making a trip out of state or country|
|Meal Benefits||28 meals (2 meals/day for 14 days) delivered to your home after discharge from inpatient acute care or a skilled nursing facility (limit 2 discharges annually)|
Extra benefit expenses are not covered under the maximum out-of-pocket limit.