Zing Elite Select IN (HMO)

Zing Elite Select IN (HMO) H4624-026 Plan Details
3 out of 5 stars

Zing Elite Select IN (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-026

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

Zing Elite Select IN (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-026

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Zing Elite Select IN (HMO) H4624-026 Plan Details
3 out of 5 stars

Zing Elite Select IN (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-026

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

Indiana Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $3900
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $25.00
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$325.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Urgent Care
Copayment for Urgent Care $0.00 to $5.00

Minimum for Urgent Care Services provided by a PCP. Maximum for Urgent Care Services provided by Other.

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0.00
Maximum Plan Benefit of $100000.00
Emergency Room Visit
Copayment for Emergency Care $120.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0.00
Maximum Plan Benefit of $100000.00
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $200.00

Air Ambulance:
Coinsurance for Air Ambulance Services 20%

Please see Evidence of Coverage for Prior Authorization rules
Prior authorization required

Health Care Services and Medical Supplies

Zing Elite Select IN (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $15.00
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Coinsurance for Medicare-covered Diabetic Supplies 0% to 20%
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment
This Plan has preferred Vendors/Manufacturers - Please see Evidence of Coverage
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00 to $25.00
Copayment for Medicare-covered Lab Services $0.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $50.00 to $150.00
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$325.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $25.00
Copayment for Medicare-covered Group Sessions $25.00
Prior Authorization Required for Outpatient Mental Health Services
Prior authorization required
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $250.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $90.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $195.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $20.00
Copayment for Medicare-covered Group Sessions $20.00
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $198.00 every three months
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $25.00
Copayment for Routine Foot Care $0.00
  • Maximum 6 visits every year
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$203.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Preventive Dental:
Copayment for Office Visit $0.00
Office Vists include:
    • Maximum 1 visit every six months
    Copayment for Oral Exams $0.00
    • Maximum 1 visit every six months
    Copayment for Prophylaxis (Cleaning) $0.00
    • Maximum 1 visit every six months
    Copayment for Fluoride Treatment $0.00
    • Maximum 1 visit every year
    Copayment for Dental X-Rays $0.00
    • Maximum 1 visit every year
    Maximum Plan Benefit of $2000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined

    Comprehensive Dental:
    Copayment for Medicare-covered Benefits $0.00
    Copayment for Non-routine Services $0.00
    Copayment for Diagnostic Services $0.00
    Copayment for Restorative Services $0.00
    Copayment for Endodontics $0.00
    Copayment for Periodontics $0.00
    Copayment for Extractions $0.00
    • Maximum 1 visit every year
    Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
    Maximum Plan Benefit of $2000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined
    Prior Authorization Required for Comprehensive Dental
    Prior authorization required

    Vision Benefits

    The following vision services are covered from in-network providers.

    Coverage Cost
    Vision Benefits
    In-Network:

    Eye Exams:
    Copayment for Medicare Covered Benefits $25.00
    Copayment for Routine Eye Exams $0.00
    • Maximum 1 Routine Eye Exam every year

    Eyewear:
    Copayment for Medicare-Covered Benefits $0.00
    Copayment for Contact Lenses $0.00
    • Maximum 1 Pair every year
    Copayment for Eyeglasses (lenses and frames) $0.00
    • Maximum 1 Pair every year
    Copayment for Eyeglass Lenses $0.00
    • Maximum 1 Pair every year
    Copayment for Eyeglass Frames $0.00
    • Maximum 1 Pair every year
    Maximum Plan Benefit of $250.00 every year for all Non-Medicare covered eyewear

    Hearing Benefits

    The following hearing services are covered from in-network providers.

    Coverage Cost
    Hearing Benefits
    In-Network:

    Hearing Exams:
    Copayment for Medicare Covered Benefits $25.00
    Copayment for Routine Hearing Exams $0.00
    • Maximum 1 visit every year
    Copayment for Fitting/Evaluation for Hearing Aid $0.00
    • Maximum 1 visit every three years

    Hearing Aids:
    Copayment for Hearing Aids - Inner Ear $0.00
    • Maximum 2 Hearing Aids - Inner Ear every three years
    Copayment for Hearing Aids - Outer Ear $0.00
    • Maximum 2 Hearing Aids - Outer Ear every three years
    Copayment for Hearing Aids - Over the Ear $0.00
    • Maximum 2 Hearing Aids - Over the Ear every three years
    Maximum Plan Benefit of $750.00 every three years per ear
    Members are provided: ?Three follow-up visits ?3-year repair warranty ?3 years of batteries included ?One-time replacement coverage for lost, stolen or damaged hearing aids -In the event a Hearing Aid is lost stolen or damaged, the member pays a deductible ($175-$225) depending on the specific manufacturer of the hearing aid in question.

    Preventive Services and Health/Wellness Education Programs

    The following services are covered from in-network providers.

    Coverage Cost
    Preventive Services and Health/Wellness Education Programs
    In-Network:
    $0.00 copay for Medicare Covered Preventive Services:

    Abdominal aortic aneurysm screening
    Alcohol misuse screenings & counseling
    Bone mass measurements (bone density)
    Cardiovascular disease screenings
    Cardiovascular disease (behavioral therapy)
    Cervical & vaginal cancer screening
    Colorectal cancer screenings
    Depression screenings
    Diabetes screenings
    Diabetes self-management training
    Glaucoma tests
    Hepatitis B (HBV) infection screening
    Hepatitis C screening test
    HIV screening
    Lung cancer screening
    Mammograms (screening)
    Nutrition therapy services
    Obesity screenings & counseling
    One-time Welcome to Medicare preventive visit
    Prostate cancer screenings(PSA)
    Sexually transmitted infections screening & counseling
    Shots:
    • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit