SSM Health Plan Harmony (HMO-POS) is a Medicare Advantage (Part C) Plan by WellFirst Health.
This page features plan details for 2023 SSM Health Plan Harmony (HMO-POS) H8019 – 003 – 0 available in St. Louis Metro Area.
SSM Health Plan Harmony (HMO-POS) is offered in the following locations.
SSM Health Plan Harmony (HMO-POS) offers the following coverage and cost-sharing.
Insurer: | WellFirst Health |
Health Plan Deductible: | $0.00 |
MOOP: | $10,000 In and Out-of-network $3,250 In-network |
Drugs Covered: | No |
Ready to sign up for SSM Health Plan Harmony (HMO-POS) ?
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
SSM Health Plan Harmony (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $50.00.
Premium Reduction: | $50.00 |
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$164.90 | $0.00 | $50.00 | $114.90 |
SSM Health Plan Harmony (HMO-POS) also provides the following benefits.
In-Network: No |
Diagnostic services: | In-Network: 0-50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Diagnostic services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Endodontics: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Endodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Extractions: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Extractions: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Non-routine services: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Non-routine services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Periodontics: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Periodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Restorative services: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Restorative services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Cleaning: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Cleaning: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | In-Network: $0-120 copay (authorization required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | Out-of-Network: 40% coinsurance (authorization required) (referral not required) |
Diagnostic tests and procedures: | In-Network: $15 copay (authorization not required) (referral not required) |
Diagnostic tests and procedures: | Out-of-Network: 40% coinsurance (authorization not required) (referral not required) |
Lab services: | In-Network: $0 copay (authorization not required) (referral not required) |
Lab services: | Out-of-Network: 40% coinsurance (authorization not required) (referral not required) |
Outpatient x-rays: | In-Network: $10 copay (authorization required) (referral not required) |
Outpatient x-rays: | Out-of-Network: 40% coinsurance (authorization required) (referral not required) |
Primary: | In-Network: $0 copay |
Primary: | Out-of-Network: $75 copay per visit |
Specialist: | In-Network: $0-35 copay per visit (authorization not required) (referral not required) |
Specialist: | Out-of-Network: $75 copay per visit (authorization not required) (referral not required) |
Emergency: | $125 copay per visit (always covered) |
Urgent care: | $0-35 copay per visit (always covered) |
Foot exams and treatment: | In-Network: $35 copay (authorization not required) (referral not required) |
Foot exams and treatment: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
Routine foot care: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Routine foot care: | Out-of-Network: $75 copay (limits may apply) (authorization not required) (referral not required) |
In-Network: $300 copay | |
Out-of-Network: $300 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing aids: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing exam: | In-Network: $35 copay (authorization not required) (referral not required) |
Hearing exam: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
In-Network: $325 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) | |
Out-of-Network: $750 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) |
In-Network: $0-300 copay per visit (authorization required) (referral not required) | |
Out-of-Network: 40% coinsurance per visit (authorization required) (referral not required) |
$10,000 In and Out-of-network $3,250 In-network |
Diabetes supplies: | In-Network: $0 copay (authorization not required) |
Diabetes supplies: | Out-of-Network: 40% coinsurance per item (authorization not required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 0-15% coinsurance per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 40% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 40% coinsurance per item (authorization required) |
Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
Chemotherapy: | Out-of-Network: 20% coinsurance (authorization required) |
Other Part B drugs: | In-Network: $2-47 copay or 20% coinsurance (authorization required) |
Other Part B drugs: | Out-of-Network: 20% coinsurance (authorization required) |
Inpatient hospital – psychiatric: | In-Network: $325 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) |
Inpatient hospital – psychiatric: | Out-of-Network: $750 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) |
Outpatient group therapy visit: | In-Network: $0 copay (authorization not required) (referral not required) |
Outpatient group therapy visit: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | In-Network: $0 copay (authorization not required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit: | In-Network: $0 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | In-Network: $0 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: $75 copay (authorization not required) (referral not required) |
No |
In-Network: $0 copay (authorization not required) (referral not required) | |
Out-of-Network: $30 copay (authorization not required) (referral not required) |
Occupational therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Occupational therapy visit: | Out-of-Network: $75 copay (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | Out-of-Network: $75 copay (authorization required) (referral not required) |
In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 100 (authorization required) (referral not required) | |
Out-of-Network: $150 per day for days 1 through 100 (authorization required) (referral not required) |
In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Contact lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Other: | Not covered (no limits) |
Routine eye exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Upgrades: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Covered (authorization not required) (referral not required) |
Ready to sign up for SSM Health Plan Harmony (HMO-POS) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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