Medicare Online Forms & Plan Documents
Find everything you need in our collection of Medicare plan forms and documents.
13437
This plan also includes a $60 quarterly allowance that will be loaded to your Flex Card and can be used to purchase eligible over-the-counter health and wellness items. Any unused quarterly allowance will not be carried over from quarter to quarter. (Refer to the policy for more information and a complete description of these benefits.)
13438
One complete initial oral exam; periodic or routine oral exams (3 times per calendar year); routine cleaning, scaling, and polishing (3 times per calendar year); single tooth radiographs; bitewing radiographs (once each 6 months); full mouth radiographs, seven or more films, or panoramic radiograph with bitewing radiographs (once each 60 months); study models and casts used in planning treatment (once each 60 months); and emergency exams.
13434
Fitness Benefit - A $1,500 allowance will be loaded to your Flex Card and can be used for expenses such as membership and class fees paid to: facilities with pools, water aerobics (and other classes) and aqua therapy; a pool-only facility; an in-person health club with a variety of cardiovascular and strength-training equipment; an in-person fitness studio that provides instructor-led group classes for cardiovascular and strength-training programs; a virtual/online membership, subscription, program, or class that provides cardiovascular and strength-training using a digital platform; or for ho
13443
Enhanced Dental Benefits for Members with Oral Cancer, Sjogren's syndrome, mental health conditions, or intellectual and/or developmental disabilities - A member is eligible to receive Enhanced Dental Benefits when the member has been diagnosed with oral cancer, Sjogren's syndrome, mental health conditions, or intellectual and/or developmental disabilities.
13442
Enhanced Dental Benefits for Members with Diabetes, Coronary Artery Disease, Suffered a Stroke or Members who Are Pregnant - A member is eligible to receive Enhanced Dental Benefits when one of the following situations applies: the member has been diagnosed with diabetes or coronary artery disease or suffered a stroke or the member is pregnant.
13441
Enhanced Dental Benefits for Members with Oral Cancer, Sjogren's syndrome, mental health conditions, or intellectual and/or developmental disabilities - A member is eligible to receive Enhanced Dental Benefits when the member has been diagnosed with oral cancer, Sjogren's syndrome, mental health conditions, or intellectual and/or developmental disabilities. For a qualified member, Enhanced Dental Benefits include dental cleanings (oral prophylaxis) four times each calendar year, fluoride treatment four times each calendar year, and pre-diagnostic cancer screening twice each calendar year.
13439
Periodic or routine oral exams (three times each calendar year).
13440
Routine cleaning, scaling, and polishing of the teeth (three times each calendar year).