Zing Select Diabetes & Heart IN (HMO C-SNP)

Zing Select Diabetes & Heart IN (HMO C-SNP) H4624-011 Plan Details
3 out of 5 stars

Zing Select Diabetes & Heart IN (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-011

Have Medicare questions?

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

$0.00
Monthly Premium

Zing Select Diabetes & Heart IN (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-011

Have Medicare questions?

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

Zing Select Diabetes & Heart IN (HMO C-SNP) H4624-011 Plan Details
3 out of 5 stars

Zing Select Diabetes & Heart IN (HMO C-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Zing Health
Plan ID: H4624-011

Have Medicare questions?

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

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $4500
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 $15.00 to $25.00
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$350.00 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 $10.00

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 Select Diabetes & Heart IN (HMO C-SNP) 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
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Coinsurance for Medicare-covered Diabetic Supplies 0% to 20%
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Prior authorization required
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:
$350.00 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 $30.00
Copayment for Medicare-covered Group Sessions $30.00
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 $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
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $30.00
Copayment for Medicare-covered Group Sessions $30.00
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 $168.00 every month
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $15.00
Copayment for Routine Foot Care $0.00
  • Maximum 12 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 $0.00 to $30.00
    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 $350.00 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 $30.00
    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 year 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