In-Network: $0 copay per visit

In-Network: $250 copay per day for days 1-5, $0 copay per day for days 6-90.

In-Network: $0 copay per day for days 1-20, $221 copay per day for days 21-100.

In-Network: $150 copay per visit

In-Network: $0 copay for Medicare-covered urgently-needed-care visits.

In-Network: $175 copay per trip

In-Network: $0 copay for Medicare-covered Dental Services

This plan includes: Eye Exams, Eyewear.

In-Network: $0 copay for Medicare-covered Hearing Services

In-Network: $0 copay; Maximum plan benefit coverage of $90.00 every 3 month.

In-Network: $0 copay; Limit of 24 visits every year.

In-Network: $0 copay for Fitness Benefit.