Premium $0 Key Extra Benefits Dental Level 4, Routine Eye Exam, Eyewear

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Premium$0Key Extra BenefitsDental Level 5, Routine Eye Exam, Eyewear Credit, OTC Debit

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Premium$0Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, OTC Debit

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Premium$0 ; Part B Rebate: $50MOOP $3,200PCP$0Specialist$25Referrals RequiredNoInpatient Hospital$175 (days 1-5)Ambulatory Surgery Center$0

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Premium $0 ; Part B Rebate: $50 MOOP  $3,200 PCP $0 Specialist

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