Vibra Health Plan  
Enhanced Complete PPO

This plan is a Medicare Advantage plan, also known as Medicare Part C. It covers all of your Medicare Part A and Part B healthcare costs, and your Part D prescription drug costs

Enroll Now

Plan Details


Vibra Health Plan Enhanced Complete PPO
Monthly Premium $25
Medical Deductible $0
Primary Care Copay In-network $5 | Out-of-network $5
Specialist Copay In-network $25 | Out-of-network $25
Routine Vision Coverage One eye exam per calendar year:  
In-network $20 copay / Out-of-network 50% coinsurance / $125 allowance toward eyeglass frames or contact lenses every 2 years.
Eyeglass, Contacts & Frames Coverage Plan provides coverage for contact lenses, eyeglass frames, and standard eyeglass lenses. Please refer to Summary of Benefits for details.
Hearing Coverage In-network $0 / Out-of-network 50% coinsurance for routine hearing exam and hearing aid fitting evaluation ($400 allowance every 3 years for hearing aids).
Preferred Pharmacy Initial Coverage (tiered coverage 1/2/3/4/5/6) $0 | $0 | $40 | $93 | 33% | $0
Standard Pharmacy Initial Coverage (tiered coverage 1/2/3/4/5/6) $15 | $20 | $47 | $100 | 33% | $7
Gap Coverage 25% Generic Drugs / 25% Brand
Out-of-pocket Max $5,800 In-network / $10,000 Combined
Enhanced Dental Coverage

Limit 2 Visit per Contract (Calendar) Year


In-network $10 | Out-of-network 50% coinsurance 
 
Visit Includes: Exam, Cleaning, 2 Bitewing X-Rays, Excludes Fluoride Treatments 
 
Medicare-Covered Benefits: Physician Specialist Copay 
 
In-network and Out-of-Network:
Wrap-Around: $2,000 Max Plan Allowance per Contract (Calendar) Year After: 
 
50% Coinsurance Palliative Emergency Treatment 
50% Coinsurance Amalgam and Composite Fillings 
50% Coinsurance Simple Extractions 
50% Coinsurance Endodontics 
50% Coinsurance Major Restorative (Crowns, Inlays, Onlays) 
50% Coinsurance Prosthodontics 
50% Coinsurance Adjustments and Repairs of Prosthetics 
 
Out-of-network Coinsurance Applied to Charges
Over-the-counter $35 monthly allowance for over-the-counter (OTC) drugs and supplies. Unused allowance may not be carried over from the one month to the next.
Transportation Benefit 24 plan approved round trips.
Meals Benefit - Post Hospital Discharge 2 meals per day for 7 days.
In-home Support Services: Grandkids on Demand 5 hours per month included.
Landmark Health Included.
Medical Nutritional Therapy Included.
Nutritional/Dietary Benefits Included.
Fresh Produce Subscription Included.
AmWell Online Doctors  Included.
Health Coaching and Education Benefit Included.
SilverSneakers- Fitness Benefit Included.
Transitional Support Services Included.
Services Supporting Self-Direction Included.
 

For more details, please review the Summary of Benefits

You can use these Star Ratings to compare our plan's performance to other plans.

Updated December 2, 2019
H9408_WBST1220