Zing Open Access IL (HMO-POS)

Zing Open Access IL (HMO-POS) H7330-002 Plan Details
Plan too new to be measured

Zing Open Access IL (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna.
Plan ID: H7330-002.

$25.00
Monthly Premium

Zing Open Access IL (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna.
Plan ID: H7330-002.

Zing Open Access IL (HMO-POS) H7330-002 Plan Details
Plan too new to be measured

Zing Open Access IL (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna.
Plan ID: H7330-002.

$25.00
Monthly Premium

Illinois Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $3450
Out-of-Network: 3450
Initial Coverage Limit $4430
Catastrophic Coverage Limit $7,050
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00

Telehealth:

  • $0 copay per telehealth visit
  • You can access board certified doctors and behavioral health specialist via phone and/or video technology for diagnosis and treatment of certain non emergency medical conditions.
  • Doctors can diagnose and prescribe medications if medically necessary.
  • Please call us for more details.
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $25.00
Referral Required for Doctor Specialty Visit
POS (Out-of-Network):

Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $25.00
Inpatient Hospital Care
In-Network:
Acute Hospital Services:
$250.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
After day 90, your plan covers an unlimited number of days for an inpatient hospital stay.
Prior Authorization Required for Acute Hospital Services

Out-of-Network:
$250.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
After day 90, your plan covers an unlimited number of days for an inpatient hospital stay.
Prior authorization required
Urgent Care
Copayment for Urgent Care $10.00
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
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $175.00 per date of service

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 Open Access IL (HMO-POS) 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 $20.00

Manual manipulation of the spine to correct subluxation (when one or more of the bones of your spine move out of position).
POS (Out-of-Network):
Copayment for Medicare Covered Chiropractic Services $20.00
Manual manipulation of the spine to correct subluxation (when one or more of the bones of your spine move out of position).

Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:

Diabetic Supplies and Services:

  • $0 copay for preferred diabetic test strips and monitoring supplies
  • 20% coinsurance for nonpreferred diabetic test strips and monitoring supplies
  • $0 copay for diabetes selfmanagement training
  • 20% coinsurance for therapeutic shoes or shoe inserts

POS (Out-of-Network):
  • $0 copay for preferred diabetic test strips and monitoring supplies
  • 20% coinsurance for nonpreferred diabetic test strips and monitoring supplies
  • $0 copay for diabetes selfmanagement training
  • 20% coinsurance for therapeutic shoes or shoe inserts
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
POS (Out-of-Network):
Coinsurance for Medicare Covered Durable Medical Equipment 20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

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

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $50.00 to $150.00. Copayment may vary depending on the place of service.
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

POS (Out-of-Network):

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare Covered Diagnostic Procedures/Tests
$0.00
Copayment for Medicare Covered Lab Services
$25.00
Copayment for Medicare Covered Diagnostic Radiological Services $50.00 to $150.00. Copayment may vary depending on the place of service.
Coinsurance for Medicare Covered Therapeutic Radiological Services 20%
Copayment for Medicare Covered Outpatient X-Ray Services $0.00

If a member receives multiple services on the same day at the same location, only the maximum copay applies.
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization Required for Home Health Services
Prior authorization required
POS (Out-of-Network):
Copayment for Medicare Covered Home Health $0.00
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$250.00 per day for days 1 to 6
$0.00 per day for days 7 to 90

Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital.
Prior Authorization Required for Psychiatric Hospital Services

Out-of-Network:
$250.00 per day for days 1 to 6
$0.00 per day for days 7 to 90

Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital.
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
POS (Out-of-Network):
Copayment for Medicare Covered Individual Sessions $25.00
Copayment for Medicare Covered Group Sessions $25.00
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $300.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $150.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $200.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
POS (Out-of-Network):

Outpatient Hospital and ASC Services:
Copayment for Medicare Covered Outpatient Hospital Services $300.00
Copayment for Medicare Covered Ambulatory Surgical Center Services $200.00
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $25.00 per visit
Copayment for Medicare-covered Group Sessions $25.00 per visit

Opioid Treatment Services $25.00 per visit

Prior Authorization May Be Required for Outpatient Substance Abuse Services

POS (Out-of-Network):

Copayment for Medicare-covered Individual Sessions $25.00 per visit

Copayment for Medicare-covered Group Sessions $25.00 per visit

Opioid Treatment Services $25.00 per visit

Prior Authorization May Be 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 $75.00 every three months
  • The OTC benefit includes nicotine replacement therapy (NRT).
  • The OTC debit card allows members to purchase health related items from retail pharmacies as well as mail order purchases.
  • If you do not use all your quarterly OTC benefit amount when you order, the remaining balance will not accumulate to the next OTC benefit period.


You can order:

  • Online  visit NationsOTC.com/ZingHealth
  • By Phone  call a NationsOTC Member Experience Advisor at 1-877-273-3381 (TTY: 711), 24 hours a day, seven days a week, 365 days a year.
  • By Mail  Fill out and return the order form in the NationsOTC/Zing Health product catalog.
  • Retail  through an approved, in network retailer
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $25.00 per visit
Copayment for Routine Foot Care $20.00 per visit
  • Maximum 4 visits every year

POS (Out-of-Network):
Copayment for Medicare Covered Podiatry Services $25.00 per visit
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$188.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required
Out-of-Network:
$0.00 per day for days 1 to 20
$188.00 per day for days 21 to 100

Dental Benefits

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

Coverage Cost
Dental Care

In-Network:

Preventive Dental:

  • $0 copay for oral exams up to one (1) every six (6) months
  • $0 copay for prophylaxis (cleaning) up to one (1) every six (6) months
  • $0 copay for a fluoride treatment for up to one (1) every year
  • $0 copay for bitewing x-rays up to one (1) set per year
  • $0 copay for panoramic x-rays for up to one (1) every five (5) years

Maximum Plan Benefit of $2,500 benefit allowance every year for preventive and comprehensive dental benefits combined.

You are responsible for all cost beyond the maximum allowed amount.

Not covered out-of-network


Comprehensive Dental:

  • $0 copay for amalgam and/or composite filling every three (3) years per tooth
  • $0 copay for extractions one (1) extraction per tooth, per year
  • $0 copay for root canals one (1) per lifetime, per tooth
  • $0 copay for scaling/root planning (deep cleaning) every (24) months per quadrant
  • $0 copay for complete crown every five (5) years, per tooth
  • $0 copay for dentures or fixed prosthetics/partials once every five (5) years

Maximum Plan Benefit of $2,500 benefit allowance every year for preventive and comprehensive dental benefits combined.

You are responsible for all cost beyond the maximum allowed amount.

Not covered out-of-network

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 $20.00
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exam every year
Maximum Plan Benefit of $290.00 every year for Eye Exams and Eyewear combined

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
POS (Out-of-Network):

Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $25.00

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
"Access to a nationwide network of 4,000+ providers

"Hearing aids available from all major brands

"Concierge services by dedicated Member Experience Advisors

"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.


POS (Out-of-Network):

Medicare Covered Hearing Services:
Copayment for Medicare Covered Hearing Exams $25.00

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
    POS (Out-of-Network):

    Medicare-covered Zero Dollar Preventive Services:
    Copayment for Medicare Covered Medicare-covered Preventive Services $0.00