¿Qué es una Lista de Medicamentos? Una Lista de Medicamentos, o Formulario, es una lista de los medicamentos con receta que cubre su plan. Su plan y un equipo de proveedores de cuidado de la salud colaboran en la selección deH5322-031-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com You are now accessing JARVIS as: {{loggedInUserName}}, (PID: {{loggedInUserPartyId}}) (WID: {{loggedInUserAgentId}})The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage. 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-031-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-033-000; 2023 UnitedHealthcare Dual Complete Plan Quick Reference Guide for Oklahoma; 2022 Plan Resource Materials. 2022 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions ... 2022 Summary of Benefits GNHH4HIEN_22_C H5216228000SB22 SBOSB035 HumanaChoice SNP-DE H5216-228 (PPO D-SNP) Oklahoma Select Counties in Oklahoma 2022 Summary of Benefits GNHH4HIEN_22_C H5216228000SB22 SBOSB035 HumanaChoice SNP-DE H5216-228 (PPO D-SNP) Oklahoma Select Counties in Oklahoma H5322-030-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_030_000_2023_M2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-031-000 Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229003319ZY0066_ANOC_H5322_031_000_2023_SP_M. Y0066_210610_INDOI_C Encuentre las actualizaciones de su plan para el próximo año 2019 UnitedHealthcare Dual Complete (HMO SNP) - H5322-031-0 in OK Plan Benefits Explained ¿Qué es una Lista de Medicamentos? Una Lista de Medicamentos, o Formulario, es una lista de los medicamentos con receta que cubre su plan. Su plan y un equipo de proveedores de cuidado de la salud colaboran en la selección de Quick reference guide 2022 UnitedHealthcare Care Provider Administrative Guide iii Contact UnitedHealthcare Most questions can be answered using our online solutions at uhcprovider.com. 2022 UnitedHealthcare Dual Complete LP (HMO D-SNP) - H5322-031-0 in OK Star Rating DetailsThe UnitedHealthcare Dual Complete LP (HMO D-SNP) (H5322 - 031) currently has 23,586 members. There are 114 members enrolled in this plan in Craig, Oklahoma, and 23,493 members in Oklahoma. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars.H5322-031-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCCommunityPlan.com Y0066_SB_H5322_031_000_2022_MThe UnitedHealthcare Dual Complete LP (HMO D-SNP) (H5322 - 031) currently has 23,586 members. There are 114 members enrolled in this plan in Craig, Oklahoma, and 23,493 members in Oklahoma. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars.We would like to show you a description here but the site won’t allow us.H5322-030-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_030_000_2023_MDoctor Specialty Visit: Copayment for Physician Specialist Office Visit $0.00. Prior Authorization Required for Doctor Specialty Visit. Inpatient hospital care. In-Network: Acute Hospital Services: $0.00 per day for days 1 to 6. $0.00 per day for days 7 to 90. Prior Authorization Required for Acute Hospital Services.2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-031-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-033-000; 2023 UnitedHealthcare Dual Complete Plan Quick Reference Guide for Oklahoma; 2022 Plan Resource Materials. 2022 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions ... 2022 Summary of Benefits GNHH4HIEN_22_C H5216228000SB22 SBOSB035 HumanaChoice SNP-DE H5216-228 (PPO D-SNP) Oklahoma Select Counties in Oklahoma H5322-031: Download: H5322-031 - UnitedHealthcare Dual Complete LP (HMO D-SNP) 2023: H5322-031: Download: H8125-003 - UnitedHealthcare Dual Complete LP1 (HMO D-SNP)Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0.00. Prior Authorization Required for Doctor Specialty Visit. Inpatient hospital care. In-Network: Acute Hospital Services: $0.00 per day for days 1 to 6. $0.00 per day for days 7 to 90. Prior Authorization Required for Acute Hospital Services.o UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 - UL4 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino o UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 - UL4 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino Emergency care/Urgent care. • Emergency: $0 or $90 copay per visit (always covered) • Urgent care: $0 or $65 copay per visit (always covered) Inpatient hospital coverage. • In 2020 the amounts for each benefit period are $0 or: $1,408 deductible for days 1 through 60. $352 copay per day for days 61 through 90.2023 Evidence of Coverage for UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Table of Contents Questions? Call Customer Service at 1-866-842-4968, TTY 711, 8am-8pm: 7 Days Oct-UnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.PCA-1-21-02928-M&R-QRG_08252021 Sample member ID cards for illustration only; actual information varies depending on payer, plan and other requirements.Y0066_EOC_H5322_031_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageCigna Alliance Medicare (HMO) H3949-031 1 Summary of Benefits H3949_23_791509_M Better benefits supported by a dedicated network of providers with no referrals required To Join You must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Service Area Bucks, Chester, Delaware, Montgomery, and Philadelphia Resources and tools for providers and health care ...2022 UnitedHealthcare Dual Complete LP (HMO D-SNP) - H5322-031-0 in OK Star Rating Details¿Qué es una Lista de Medicamentos? Una Lista de Medicamentos, o Formulario, es una lista de los medicamentos con receta que cubre su plan. Su plan y un equipo de proveedores de cuidado de la salud colaboran en la selección de Vendor Information UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Take advantage of your additional plan benefits by using the providers below or contacting Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Área de servicio: Oklahoma - condados de Adair, Alfalfa, Atoka, Beaver, Beckham, Blaine, Bryan,Learn more about the UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plan for Oklahoma. Check eligibility, explore benefits, and enroll today.¿Qué es una Lista de Medicamentos? Una Lista de Medicamentos, o Formulario, es una lista de los medicamentos con receta que cubre su plan. Su plan y un equipo de proveedores de cuidado de la salud colaboran en la selección deCatastrophic drug coverage limit. $7,400.00. Primary care doctor visit. $0 in-network / $55 out-of-network. Specialty doctor visit. $35 in-network / $60 out-of-network. Inpatient hospital care. $375 per day, days 1-5; $0 per day, days 6-90 in-network / 50% per stay out-of-network. Urgent care.Learn more about the UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plan for Oklahoma. Check eligibility, explore benefits, and enroll today.H3749-001-000, H3749-017-000, H3749-018-000, H3749-020-000, H8768-008-000, H8768-009-000, H8768-016-000, H8768-028-000, H5322-031-000. NEW 2023: H0271-053-000, H5322-033-000. Texas: Corpus Christi: For WellMed impacted plans, billing instructions, provider eligibility and other details, please reference https://www.wellmedhealthcare.com ...Introduction If you have a medical emergency, get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Emergency care can always be obtained in or out of the service areaThe UnitedHealthcare Dual Complete LP (HMO D-SNP) (H5322 - 031) currently has 23,586 members. There are 528 members enrolled in this plan in Canadian, Oklahoma, and 23,493 members in Oklahoma. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-031-000 Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229003319Z2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete LP (HMO D-SNP) Location: Tillman, Oklahoma Click to see other locations. Plan ID: H5322 - 031 - 0 Click to see other plans. Member Services: 1-844-368-7150 TTY users 711. 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-031-000 Subject UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Llame al número gratuito 1-800-313-0973 (TTY 711). Se encuentran disponibles agentes con licencia del 1 de octubre al 31 de marzo, de 8 a. m. a 8 p. m. , hora local, Number of Members enrolled in this plan in (H5322 - 030): 3,347 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage. Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0.00. Prior Authorization Required for Doctor Specialty Visit. Inpatient hospital care. In-Network: Acute Hospital Services: $0.00 per day for days 1 to 6. $0.00 per day for days 7 to 90. Prior Authorization Required for Acute Hospital Services. The UnitedHealthcare Dual Complete LP (HMO D-SNP) (H5322 - 031) currently has 23,586 members. There are 528 members enrolled in this plan in Canadian, Oklahoma, and 23,493 members in Oklahoma. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars.2023 Evidence of Coverage for UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Table of Contents Questions? Call Customer Service at 1-866-842-4968, TTY 711, 8am-8pm: 7 Days Oct- 2019 UnitedHealthcare Dual Complete (HMO SNP) - H5322-031-0 in OK Plan Benefits Explained o UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 - UL4 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-031-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-033-000; 2023 UnitedHealthcare Dual Complete Plan Quick Reference Guide for Oklahoma; 2022 Plan Resource Materials. 2022 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions ...UnitedHealthcare - H5322 For 2023, UnitedHealthcare - H5322 received the following Star Ratings from Medicare: Overall Star Rating: 5 stars Health Services Rating: 5 stars Drug Services Rating: 4.5 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ... UnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-031-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H5322-033-000; 2023 UnitedHealthcare Dual Complete Plan Quick Reference Guide for Oklahoma; 2022 Plan Resource Materials. 2022 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions ... H5322-031-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCCommunityPlan.com Y0066_SB_H5322_031_000_2022_M Plan ID: H5322-031-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Oklahoma Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ... Y0066_EOC_H5322_031_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Jan 1, 2023 · H5322-033-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_033_000_2023_M TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: Y0036_23_835509S_M. Adenda para el Resumen de beneficios de 2023 Impactos de la Ley de Reducción de la Inflación . En agosto de 2022, se aprobó una nueva ley, conocida como Ley de ReducciónNumber of Members enrolled in this plan in (H5322 - 030): 3,347 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...UnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Service area: Oklahoma - Adair, Alfalfa, Atoka, Beaver, Beckham, Blaine, Bryan, Caddo, Canadian,729 Medicare Advantage Plans from Humana. Coverage varies by plan. Select a Medicare Advantage Plan below to view details about the coverage it provides: Plan CodePlan Name. H0028:007-0 Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) H0028:014-0 Humana Gold Plus H0028-014 (HMO) H0028:015-0 Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP) H0028 ... Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Área de servicio: Oklahoma - condados de Adair, Alfalfa, Atoka, Beaver, Beckham, Blaine, Bryan,h5322 care improvement plus south central insurance co. h5325 coventry health care of kansas, inc. h5410 healthspring of florida, inc. h5420 h5422 blue cross blue shield healthcare plan of georgia h5425 scan health plan h5427 078 freedom health, inc. h5431 healthsun health plans, inc. h5433 orange county health authority h5447 community first ...H5322-030-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_030_000_2023_MPlan Name Effective Year Benefit Package Summary; H5322-031 - UnitedHealthcare Dual Complete LP (HMO D-SNP) 2023: H5322-031: Download: AARP Medicare Advantage Plan 1 (HMO-POS)Provider Directory 2023 UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Oklahoma Canadian, Cleveland, Kingfisher, Lincoln, Logan and Oklahoma Counties Y0066_ANOC_H5322_031_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ... Introduction If you have a medical emergency, get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Emergency care can always be obtained in or out of the service areaUnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. UnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. The UnitedHealthcare Dual Complete LP (HMO D-SNP) (H5322 - 031) currently has 13,894 members. There are 309 members enrolled in this plan in Creek, Oklahoma, and 13,829 members in Oklahoma. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars. The detail CMS plan carrier ratings are as ... Provider Directory 2023 UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Oklahoma Mayes, Okmulgee and Rogers Counties Some network providers may have been added or removed from our network after this directoryResources and tools for providers and health care ...UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) 5 out of 5 stars. UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H5322-031. $ 0.00.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-031-000 Subject UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Y0066_ANOC_H5322_031_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ...H5322-030-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_030_000_2023_MH5322-031-000, H0271-053-000, H5322-033-000. 2 Table of contents UnitedHealthcare hospice VBID model overview ...
H5322-031-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com. Where did lowe
Y0066_EOC_H5322_031_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Introduction If you have a medical emergency, get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Emergency care can always be obtained in or out of the service areao UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 - UL4 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number2022 UnitedHealthcare Dual Complete LP (HMO D-SNP) - H5322-031-0 in OK Star Rating DetailsY0066_EOC_H5322_031_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage H5322-031-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com 2022 UnitedHealthcare Dual Complete LP (HMO D-SNP) - H5322-031-0 in OK Star Rating Details UnitedHealthcare offers UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 plans for Oklahoma and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.Number of Members enrolled in this plan in (H5322 - 031): 5,075 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...H3749-001-000, H3749-017-000, H3749-018-000, H3749-020-000, H8768-008-000, H8768-009-000, H8768-016-000, H8768-028-000, H5322-031-000. NEW 2023: H0271-053-000, H5322-033-000. Texas: Corpus Christi: For WellMed impacted plans, billing instructions, provider eligibility and other details, please reference https://www.wellmedhealthcare.com ...UnitedHealthcare - H5322 En el año 2023, UnitedHealthcare - H5322 recibió las siguientes Calificaciones con Estrellas de Medicare: Calificación General por Estrellas: 5 estrellas Calificación de los Servicios de Salud: 5 estrellas Calificación de los Servicios de Medicamentos: 4.5 estrellas2023 Evidence of Coverage for UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Table of Contents Questions? Call Customer Service at 1-866-842-4968, TTY 711, 8am-8pm: 7 Days Oct-Maximum 3 visits every year. Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3500.00 every year for Preventive and Non-Medicare Covered Comprehensive combined.H5322-030-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_030_000_2023_M.
