For Medicare beneficiaries who need prescription drug coverage and qualify for no/partial Extra Help

• Medicare Prescription Drug Coverage (Part D)
• $0 premium
• $10 co-payments for primary care visits
• No referral needed to see a specialist
• $0 for annual dental cleaning and exam including enhanced benefits
• $0 annual routine eye exam
• Up to $150 in eyewear per year or up to $150 contact lens allowance
• Up to $500 for hearing aids every three years
• $5 copayments for up to 8 acupuncture visits per year
• Free car service to and from your doctor up to 12 round trips per year

You must reside in the following counties of New Jersey State: Bergen, Essex, Hudson, Passaic, or Union.

Your Summary of Benefits will give you important information concerning all your benefits such as applicable conditions and limitations, premiums, out-of-network coverage, cost-sharing and any conditions associated with the receipt or use of these benefits.

You can also reference your Evidence of Coverage to find out more about grievances, exceptions, coverage determinations, appeals procedures and our quality assurance policies and procedures.

For Medicare beneficiaries who qualify for prescription assistance and want Medicare to cover their drug costs

• Medicare Prescription Drug Coverage (Part D)
• $35 premium
• $10 co-payments for primary care visits
• No referral needed
• $0 for annual dental cleaning and exam, including progressive dental benefits
• $0 annual routine eye exam
• Up to $150 credit for non-plan covered frames OR up to $150 contact lens allowance
• Up to $500 for hearing aids every three years
• Free car service to and from your doctor up to 16 round trips per year

You must reside in the following counties of New Jersey State: Bergen, Essex, Hudson, Passaic, or Union.

Your summary of benefits will give you important information concerning all your benefits such as applicable conditions and limitations, premiums, out-of-network coverage, cost-sharing and any conditions associated with the receipt or use of these benefits.

You can also reference your Evidence of Coverage to find out more about grievances, exceptions, coverage determinations, appeals procedures and our quality assurance policies and procedures.

For Medicare beneficiaries who have creditable prescription drug coverage

• $10 co-payments for primary care visits
• $0 premium
• No referral needed
• $0 for annual dental cleaning and exam including enhanced benefits
• $0 annual routine eye exam
• Up to $150 credit for non-plan covered frames OR up to $150 contact lens allowance
• Up to $500 for hearing aids every three years
• Free car service to and from your doctor up to 8 round trips per year
• No Medicare Part D Prescription Drug Coverage

You must reside in the following counties of New Jersey State: Bergen, Essex, Hudson, Passaic, or Union.

Your Summary of Benefits will give you important information concerning all your benefits such as applicable conditions and limitations, premiums, out-of-network coverage, cost-sharing and any conditions associated with the receipt or use of these benefits.

You can also reference your Evidence of Coverage to find out more about grievances, exceptions, coverage determinations, appeals procedures and our quality assurance policies and procedures.

A special needs plan for Medicare beneficiaries who also qualify for Medicaid

• Medicare Prescription Drug Coverage (Part D)
• $0 co-payments for primary care visits
• 20% coinsurance for specialist visits
• No referrals needed
• 20% coinsurance for Medicare-covered eye exam
• $0 for annual cleaning and dental exam plus enhanced dental
• Up to $270 a year ($22.50 per month) for non-prescription drugs and health related over-the counter items
• Free car service to and from your doctor up to 12 round trips per year

You must reside in the following counties of New Jersey State: Bergen, Essex, Hudson, Passaic, or Union.

Your Summary of Benefits will give you important information concerning all your benefits such as applicable conditions and limitations, premiums, out-of-network coverage, cost-sharing and any conditions associated with the receipt or use of these benefits.

You can also reference your applicable Evidence of Coverage to find out more about grievances, exceptions, coverage determinations, appeals procedures and our quality assurance policies and procedures.