$0 copay per visit

$0 copay per admission (Unlimited days per admission).

$0 copay per day for days 1-20, $50 copay per day for days 21-100 (no prior hospital stay required).

$150 copay per visit (waived if admitted within 48 hours)

$0 copay for Medicare-covered urgently-needed-care visits

$50 copay per trip (waived if admitted)

$0 copay for Medicare-covered Dental Services

This plan includes: Eye Exams, Eyewear.

$0 copay for Medicare-covered Hearing Services

$0 copay; Maximum plan benefit coverage of $30.00 every month (no rollover).

$0 copay; Limit of 26 one-way trips every year to plan approved locations (within a 50-mile radius). Unlimited to AllCare Care Centers.

$0 copay for Fitness Benefit.