| 2023 Plan Benefits | LEON MediExtra (HMO) | ||
|---|---|---|---|
| Prescription Drugs | |||
| Initial Coverage Limit (ICL) | $9,000 | ||
| Dental | |||
| Comprehensive and Preventive Maximum Benefits | $5,000 | ||
| Vision | |||
| Eyewear Lenses and Frames | $500 maximum benefit (up to 3 pairs) | ||
| Contact lenses | $210 maximum benefit (up to 6 boxes of soft lenses/$35 per box) | ||
| Hearing Services | |||
| Hearing Aids | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | ||
| Drugs/OTC | |||
| OTC | $840 annual | ||
| LeonPlus | With the flexibility to choose from different options | ||
| Part B Premium Give Back | |||
| Part B Premium Reduction | not applicable | ||
| Acupuncture | |||
| Routine | $0 for 6 visits | ||
| Medical | |||
| PCP Visit | $0 | ||
| Inpatient Hospital (per admission) | $0 | ||
| Lab Services and X-Rays | $0 | ||
| 2023 Plan Benefits |
|---|
| LEON MediExtra (HMO) |
| Prescription Drugs |
| Initial Coverage Limit (ICL) |
| $9,000 |
| Dental |
| Comprehensive and Preventive Maximum Benefits |
| $5,000 |
| Vision |
| Eyewear Lenses and Frames |
| $500 maximum benefit (up to 3 pairs) |
| Contact lenses |
| $210 maximum benefit (up to 6 boxes of soft lenses/$35 per box) |
| Hearing Services |
| Hearing Aids |
| $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) |
| Drugs/OTC |
| OTC |
| $840 annual |
| LeonPlus |
| With the flexibility to choose from different options |
| Part B Premium Give Back |
| Part B Premium Reduction |
| not applicable |
| Acupuncture |
| Routine |
| $0 for 6 visits |
| Medical |
| PCP Visit |
| $0 |
| Inpatient Hospital (per admission) |
| $0 |
| Lab Services and X-Rays |
| $0 |
2023 Membership Benefits
This comprehensive plan provides an Initial Coverage limit of $9,000 for Prescription Drugs, and great supplemental benefits.
