Benefits Overview

Monthly premium	$154^†
Office visits	100% coverage for annual routine physical exam. No co-pay for scheduled primary doctor office visits. No co-pay per specialist visit. No co-pay for vision services, hearing services, podiatry, outpatient mental health, and rehabilitation therapy services per visit.
Inpatient hospital care	100% after $100, co-pay per inpatient admission.
Worldwide emergency care	$50 co-pay; co-pay is waived if admitted to the hospital within 24 hours for the same condition.
Prescription drug coverage	Prescription coverage on first $2,700 of prescription drug costs with co-pays. Once $2,700 in actual prescription drug costs is reached, prescription coverage on generic drugs with co-pays. Beyond $4,350 of out-of-pocket drug costs, $2.40-$6 co-pay or 5% co-insurance (whichever is greater) for all covered drugs.
Transportation	$0 co-pay for up to 5 round trip(s) per year to/from medical appointments and/or pharmacies.
Dental	Preventive dental paid in full. This includes: Three cleanings (one must be a gum cleaning) per calendar year Oral exams twice per calendar year. Bitewing X-rays once per calendar year.
Eyeglasses	$75 annual plan benefit maximum for eyeglasses or contacts; open network
Hearing aid benefit	$500 annual plan benefit maximum every 36 months

^†You must continue to pay your Medicare Part B premium if not paid for under Medicaid or by another third-party.

For full information on UCare Secure benefits, please contact one of our Marketing representatives.

September 2009