Laserfiche WebLink
Outpatient Medical Services and Supplies <br /> Physical/occupational therapy $20 copayment <br /> Speech/language therapy $20 copayment <br /> Durable medical equipment 80%coinsurance <br /> Prosthetics 80%coinsurance <br /> (Diabetes self-monitoring training,nutrition therapy 100%coverage <br /> (Diabetes supplies 80%coinsurance <br /> (Diagnostic tests,radiology, lab services 100%coverage <br /> IDruar Benefit,Retail Pharmacv to$4,700 Incl. extra benefit during drug coverage gap <br /> Generic drugs $15 copay/one month supply <br /> (Preferred brand drugs $25 copay/one month supply <br /> INon-preferred brand drugs $25 copay/one month supply <br /> (Specialty drugs $25 copay/one month supply <br /> The benefit information provided herein is a brief summary,not a comprehensive description of benefits. <br /> For more information refer to your Summary of Benefits, Evidence of Coverage or call Member Services at 952-883-7979 or 800-233-9645. <br /> You may be able to get Extra Help to pay for your prescription drug premiums and costs.To see if you qualify for Extra Help, call <br /> • 800-MEDICARE,(800-633-4227).TTY users should call 877-486-2048,24 hours a day/7 days a week. <br /> • The Social Security Office at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday TTY users should call 800-325-0778. <br /> • Your Medicaid Office. <br />