2025 Plan Benefits | Leon MediPlus (HMO) | ||
---|---|---|---|
Prescription Drugs | |||
Initial Coverage Phase | $2,000 | ||
Dental | |||
Comprehensive Dental Maximum Benefit | $2,750 | ||
Vision | |||
Eyewear Lenses and Frames | $500 maximum benefit (up to 3 pairs each year) | ||
Hearing Services | |||
Hearing Aids | $2,100 maximum benefit / 3 years ($1,050 per hearing aid, per ear) | ||
Drugs/OTC | |||
Maximum Annual Benefit | $600 | ||
Leon Plus Card | |||
Maximum Annual Benefit | $600 | ||
Part B Premium Give Back | |||
Part B Premium Reduction | not applicable | ||
Acupuncture | |||
Routine | $0 for up to 6 visits | ||
Medical | |||
PCP Visit | $0 | ||
Inpatient Hospital (per admission) | Day(s) 1 – 5: $50 copay Days 6 – 90: $0 copay | ||
Lab Services and X-Rays | $0 |
2025 Plan Benefits |
---|
Leon MediPlus (HMO) |
Prescription Drugs |
Initial Coverage Phase |
$2,000 |
Dental |
Comprehensive Dental Maximum Benefit |
$2,750 |
Vision |
Eyewear Lenses and Frames |
$500 maximum benefit (up to 3 pairs each year) |
Hearing Services |
Hearing Aids |
$2,100 maximum benefit / 3 years ($1,050 per hearing aid, per ear) |
Drugs/OTC |
Maximum Annual Benefit |
$600 |
Leon Plus Card |
Maximum Annual Benefit |
$600 |
Part B Premium Give Back |
Part B Premium Reduction |
not applicable |
Acupuncture |
Routine |
$0 for up to 6 visits |
Medical |
PCP Visit |
$0 |
Inpatient Hospital (per admission) |
Day(s) 1 – 5: $50 copay Days 6 – 90: $0 copay |
Lab Services and X-Rays |
$0 |
Membership Benefits
- View Leon MediPlus Summary of Benefits
- View Leon MediPlus Formulary
- View Leon MediPlus Evidence of Coverage
- View Dental Schedule of Benefits
- Request Printed Materials