Connecticut Teachers' Retirement Board 2019 Medicare Supplement Plan Benefits -- Administered By Stirling Benefits. General information
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1 Provider access Covered Benefits Deductible General information All providers who accept If covers a charge, then the TRB plan covers that charge The 2019 deductible is $185. The member pays the Part B deductible TRB Deductible The 2019 TRB deductible is $500. usually pays 80% of allowed charges for non-hospital claims. The remaining 20% will apply to the TRB deductible until $500 is met. TRB Cost Share After the TRB deductible is met, amounts not covered by are shared equally by the TRB plan and the member, until another $500 is paid by both the plan and the member. Post TRB deductible and cost share The TRB plan generally pays 100% of a members out of pocket costs after the TRB is met Unassigned Benefits Most providers accept assignment. Providers that do not accept assignment may bill an extra 15% above what allows. The TRB plan pays 100% of the extra 15% for unassigned claims. 1 January 1, 2019
2 Inpatient and Skilled Nursing Services Hospital inpatient stays payment varies by length of stay and use of reserve days TRB Supplement All expenses approved by, less a $250 copayment per admission for the first 4 admissions per year. 100% thereafter $250 per hospital admission for the first four admissions. pays $0 for any hospital admission after the first four per year. Extended Hospital Stays covers the first 90 days of a hospital admission, and also has 60 lifetime reserve days If hospital benefits are exhausted, the plan covers 100% of the cost for an additional 60 days per admission No cost for an additional 60 days per admission after benefits are exhausted. Skilled Nursing Benefit 100% of the first 20 days paid $0 $0 A daily copayment for the next 80 days 100% of the cost after satisfaction of the TRB $0.00 for the next 20 days 100% of the cost after satisfaction of the TRB Home Health Care the TRB Home Health Care-Aide Limited benefits 100% of the cost after satisfaction of the TRB Hospice Care pays in full $0 $0 2 January 1, 2019
3 Outpatient Services The following services are subject to the annual Part B deductible. TRB Supplement Primary Care visit the TRB Specialists the TRB Surgery the TRB Emergency Care the TRB Ambulance the TRB Urgent Care the TRB Physical, Speech, Occupational and Cardiac Therapy Annual Routine Vision Exam the TRB $0.00 Up to $75 once per year. No network, any provider. any costs in excess of $75 Diagnostic Vision & Hearing Exams 80% of the allowed amount if covered by 100% of the cost after satisfaction of the TRB 3 January 1, 2019
4 TRB Supplement Hearing Aids- does not cover $750 allowance every three years Costs in excess of $750 Podiatrist- four routine visit the TRB Chiropractor the TRB DME/Prosthetics the TRB Diabetes Monitoring Supplies the TRB Part B drugs the TRB Outpatient Mental Health and substance abuse the TRB Lab and X-ray, MRI, CT and other diagnostic testing the TRB Radiation therapy the TRB Kidney Dialysis the TRB 4 January 1, 2019
5 Cardiovascular Disease Screening Cervical and Vaginal Cancer Screening (Pap test and pelvic exam) Colorectal Screening - every 10 years if not high risk Diabetes Screening Flu Vaccination and Administration-Some Vaccines are covered under your Part B benefit Hepatitis B Virus (HBV) infection screening Hepatitis C screening test Connecticut Teachers' Retirement Board Routine & Preventive Services 100% once every 5 years TRB Supplement 100% every 24 months; once every 12 months if high risk 100% once every 120 months; once every 24 months if high risk 100 % up to 2 screenings each year 100% one flu shot per flu season 100% if you are high risk 100% yearly if you are high risk HIV screening 100% if you are high risk Lung cancer screening 100%; must meet specified conditions Mammogram 100% once every 12 months Medical Nutritional Therapy- up to 3 one hour visits 100%; must meet specified conditions 5 January 1, 2019
6 Obesity screenings & counseling Prostate Cancer Screening Exam -once every 12 months Connecticut Teachers' Retirement Board 100% if BMI of 30 or more 100% once every 12 months TRB Supplement Yearly "Wellness" visit 100% each 12 months Emergency and Urgent Care Outside of the US - Foreign Travel does not cover care outside the US and Puerto Rico 100% inpatient hospital up to 30 days; 80% life threatening outpatient; 20% non life threatening outpatient Remaining balance after plan allowed amounts. 6 January 1, 2019
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Initial Preventive Physical Examination (IPPE) Also known as the Welcome To Medicare Visit (WMV) Medicare Part B Preventive Services: Quick Reference Chart Effective January 1, 2009 No specific diagnosis