2021 Member Supplemental Benefit Guide
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2021 Member Supplemental Benefit Guide The products and services described in this guide are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the IU Health Plans grievance process. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status, or any other characteristic protected by federal, state or local law. © 2020 IUHealth 9/20 IUH#33477 H7220_IUHMA21212_C
As a valued member of our Medicare Advantage health plan, you receive many benefits and discounts to help you gain more from your health plan. The information included in this Member Supplemental Benefit Guide is designed to help you maximize your benefits as a member. In this guide, you will find dental, hearing, vision and fitness information, as well as a record to help you keep track of the annual Medicare-covered preventive services. Additionally, you’ll find more details regarding new 2021 benefits. We encourage you to take full advantage of these benefits and discounts. IU Health Plans Member Advocates are ready to answer your questions from 8 am – 8 pm, seven days a week (Oct. 1 – March 31), and from 8 am – 8 pm, Monday – Friday (April 1 – Sept. 30). You can also visit our website at iuhealthplans.org. We care about your healthcare and health plan experience and hope you find this guide useful.
Table of contents
Get more value from your Medicare Advantage membership with these
supplemental benefits offered by IU Health Plans and our trusted
partners.
Delta Dental..........................................................................................................................2 – 5
Summary of dental benefits within your plan, as well as
optional supplemental dental benefits
EyeMed..................................................................................................................................6 – 8
Summary of benefits and additional vision discounts
TruHearing®..........................................................................................................................9 – 10
Hearing care and product discounts
Silver&Fit® Healthy Aging and Exercise Program..................................................... 11 – 12
Mom’s Meals®.................................................................................................................. 13 – 14
Healthy Rewards Program...................................................................................................... 15
Cancer Resource Center........................................................................................................ 16
Preventive Health Checklist......................................................................................... 17 – 18
Keep track of your preventive screenings covered by Medicare
1PLEASE NOTE: If you opted for additional supplemental dental benefits (with an additional dental
premium), you will receive the dental benefits noted in your selected plan. (These supplemental
dental plans are listed on pages 3 and 4.)
Delta Dental benefit summary
To find a dentist, visit deltadentalin.com/findadentist and use the dentist search tool in the blue box
for Medicare Advantage PPO and Medicare Advantage Premier providers. You may also call customer
service at 800.330.2732 (TTY users call 711).
Customer service is available Monday – Friday, 8 am to 8 pm. Automated system is available 24/7.
Medicare Advantage PPO and Premier
Covered services Delta Dental Medicare Out-of-network dentist**
Coverage effective Jan. 1, 2021 Advantage PPO or Medicare
Advantage Premier Dentist*
Diagnostic and preventive services
Diagnostic and preventive
services – 2 exams and 100% 50%
2 cleanings
Bitewing radiographs – 2 sets of
100% 50%
bitewing X-rays
*Delta Dental’s Medicare Advantage PPO and Medicare Advantage Premier networks are in the states of
Michigan, Indiana and Ohio.
**Services received from dentists who do NOT participate in Delta Dental’s Medicare Advantage PPO
or Delta Dental’s Medicare Advantage Premier network will be processed as services received from
a non-participating dentist, and your out-of-pocket costs may be higher. Please note Delta Dental’s
Medicare Advantage PPO and Delta Dental’s Medicare Advantage Premier networks only consist of
dentists in the states of Michigan, Indiana and Ohio. If you receive services from a dentist who DOES
NOT participate in either Delta Dental’s Medicare Advantage PPO or Delta Dental’s Medicare Advantage
Premier network, YOU WILL BE RESPONSIBLE for the difference between Delta Dental’s payment to you
and the amount charged by the non-participating dentist.
If you receive services from a dentist who has affirmatively opted not to participate with Medicare, Delta
Dental will be unable to make any payments to either you or your dentist, and you will be responsible for
all costs. Prior to receiving services from your dentist, you should confirm whether or not your dentist
has affirmatively opted out of Medicare participation. If you receive services from a dentist who is on the
CMS preclusion list, Delta Dental will be unable to make any payments to either you or your dentist, and
you will be responsible for all costs.
Please see certificate for a complete list of exclusions and limitations.
H7220_IUHMA2146_M Accepted 8.1.2020 2PLEASE NOTE: As part of your Medicare Advantage plan with IU Health Plans, you receive basic
dental benefits as noted on page 2.
Additional Delta Dental plan options
To find a dentist, visit deltadentalin.com/findadentist and use the dentist search tool in the blue box
for Medicare Advantage PPO and Medicare Advantage Premier providers. You may also call customer
service at 800.330.2732 (TTY users call 711).
Customer service is available Monday – Friday, 8 am to 8 pm. Automated system is available 24/7.
All plans use Delta Dental Medicare Advantage PPO or Medicare Advantage Premier networks.
Delta Dental Medicare Advantage PPO and Premier
Covered services Basic 750 Enhanced 1000 Enhanced 1500
Coverage effective In-network Out-of- In-network Out-of- In-network Out-of-
Jan. 1, 2021 dentist network dentist network dentist network
dentist* dentist* dentist*
Rates
Monthly premium $10 $16 $22
Diagnostic and preventive services
Emergency palliative
100% after 50% after 100% after 50% after 100% after 50% after
treatment – To
deductible deductible deductible deductible deductible deductible
temporarily relieve pain
Full mouth series X-ray/
panoramic film – Or a
100% after 50% after 100% after 50% after 100% after 50% after
panorex, payable once
deductible deductible deductible deductible deductible deductible
in a 36-month period
(includes bitewing X-ray)
Basic services
Brush biopsy – 50% after 50% after 50% after 50% after 50% after 50% after
To detect oral cancer deductible deductible deductible deductible deductible deductible
Minor restorative
50% after 50% after 50% after 50% after 50% after 50% after
services – Fillings and
deductible deductible deductible deductible deductible deductible
crown repair
Endodontic services – 50% after 50% after 50% after 50% after 50% after 50% after
Root canals deductible deductible deductible deductible deductible deductible
Periodontic services – 50% after 50% after 50% after 50% after 50% after 50% after
To treat gum disease deductible deductible deductible deductible deductible deductible
(See next page for more information.)
3Additional Delta Dental plan options, continued
All plans use Delta Dental Medicare Advantage PPO or Medicare Advantage Premier networks.
Delta Dental Medicare Advantage PPO and Premier
Covered services Basic 750 Enhanced 1000 Enhanced 1500
Coverage effective In-network Out-of- In-network Out-of- In-network Out-of-
Jan. 1, 2021 dentist network dentist network dentist network
dentist* dentist* dentist*
Basic services, continued
Oral surgery services –
50% after 50% after 50% after 50% after 50% after 50% after
Extractions and dental
deductible deductible deductible deductible deductible deductible
surgery
Other basic services – 50% after 50% after 50% after 50% after 50% after 50% after
Miscellaneous services deductible deductible deductible deductible deductible deductible
Major services
Major restorative 50% after 50% after 50% after 50% after
services – Crowns deductible deductible deductible deductible
Relines and repairs – Not a covered 50% after 50% after 50% after 50% after
To bridges and dentures benefit deductible deductible deductible deductible
Prosthodontic services – 50% after 50% after 50% after 50% after
Bridges and dentures deductible deductible deductible deductible
Maximums and deductible
Contract year maximum $750 per member $1,000 per member $1,500 per member
Deductible $25 per member $25 per member $25 per member
(per contract year)
*Services received from dentists who do NOT participate in Delta Dental’s Medicare Advantage PPO or
Delta Dental’s Medicare Advantage Premier network will be processed as services received from a
non-participating dentist, and your out-of-pocket costs may be higher. Please note Delta Dental’s
Medicare Advantage PPO and Delta Dental’s Medicare Advantage Premier networks only consist of
dentists in the states of Michigan, Indiana and Ohio. If you receive services from a dentist who DOES
NOT participate in either Delta Dental’s Medicare Advantage PPO or Delta Dental’s Medicare Advantage
Premier network, YOU WILL BE RESPONSIBLE for the difference between Delta Dental’s payment to you
and the amount charged by the non-participating dentist.
Please see certificate for a complete list of exclusions and limitations.
If you receive services from a dentist who has affirmatively opted not to participate with Medicare, Delta
Dental will be unable to make any payments to either you or your dentist, and you will be responsible for
all costs. Prior to receiving services from your dentist, you should confirm whether or not your dentist
has affirmatively opted out of Medicare participation. If you receive services from a dentist who is on the
CMS preclusion list, Delta Dental will be unable to make any payments to either you or your dentist, and
you will be responsible for all costs.
4Additional Delta Dental plan options, continued
Customer Solutions Center hours
Oct. 1 to March 31, 8 am to 8 pm, seven days a week; April 1 to Sept. 30; 8 am to 8 pm,
Monday – Friday. Call 800.455.9776 (TTY/TDD 711 or 800.743.3333).
Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract.
Enrollment in an HMO or HMO POS plan from Indiana University Health Plans depends on the plan’s
contract renewal with Medicare. IU Health does not discriminate on the basis of race, color, religion,
sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender
identity and/or expression, marital status, or any other characteristic protected by federal, state or
local law.
For language assistance, call 800.455.9776 (TTY/TDD 711 or 800.743.3333).
5As a member of IU Health Plans, you now have access to all of the benefits
and advantages EyeMed Vision Care has to offer.
Whether you choose a provider based on your schedule, style or value—with the
Insight network, we have you covered:
n 107,949 providers nationwide n Convenient weekend and evening times
n 3,849 providers in the state of Indiana available at most locations
n Online, in-network providers through
n Same-day/one-hour service available at
contactsdirect.com and glasses.com some locations
n Right mix of independent and desired
n Benefits and discounts applied consistently
retail providers
We also have popular designer brands to choose from so that your eyewear meets your needs and suits
your style.
We make finding an in-network provider and using your benefit easy:
Locate a provider Receive care and Your claim is processed
Check out ways to eyewear In-network providers file
find one… Simply tell providers your claims on your behalf so
1. eyemedvisioncare.com/ name and date of birth—it’s you won’t have to worry
iuhealth easy. Providers are open about anything. For out-of-
2. Customer Care Center days, nights and weekends. network (OON) providers,
844.230.6500 members submit claims, and
OON checks are paid out daily.
Looking for more savings?
n 40% off additional pairs of glasses or prescription sunglasses (Available at in-network provider locations.)
n 20% off non-prescription sunglasses (Not insured benefits. Discounts on non-covered services may not
be available through all providers or in all stores.)
n 15% off laser vision correction (Discounts only available at participating in-network providers. Does not
apply to discount plans.)
n 20% off any remaining balance over the frame allowance (Not insured benefits. Discounts on non-covered
services may not be available through all providers or in all stores.)
Ready to learn more? Check out eyemedvisioncare.com/iuhealth. 6Explanation of your vision care benefits
Select HMO and Select Plus HMO 001, 002 and 003 plans
Vision care services In-network member cost Out-of-network
reimbursement
Exam with dilation as necessary $0 copay Up to $30
Frames $250 allowance for frame, lens and lens Up to $125
options; 20% off balance over $250
Contact lenses
(Contact lens allowance includes
materials only.)
Conventional $0 copay, $250 allowance, 15% off Up to $200
balance over $250
Disposable $0 copay, $250 allowance, plus balance Up to $200
over $250
Medically necessary $0 copay, paid in full Up to $210
Laser vision correction 15% off the retail price or 5% off the N/A
LASIK or PRK from U.S. Laser Network promotional price
Additional pairs discount Members also receive a 40% discount off N/A
complete pair eyeglass purchase and
15% off conventional contact lenses once
the funded benefit has been used.
Frequency $250 max allowance
Examination Once every 12 months
Frames and lenses or contact lenses Once every 24 months
You’re on the INSIGHT network. For a complete list of providers near you, use our Enhanced Provider
Locator on Eyemedvisioncare.com/iuhealth or call 866.804.0982. For LASIK providers, call
877.5LASER6.
EyeMed is an independent vision care program and network of providers utilized by IU Health Plans
Medicare Advantage HMO and HMO POS.
Customer Solutions Center hours
Oct. 1 to March 31, 8 am to 8 pm, seven days a week; April 1 to Sept. 30, 8 am to 8 pm, Monday –
Friday. Call 800.455.9776 (TTY/TDD 711 or 800.743.3333). Indiana University Health Plans is a
Medicare Advantage organization with a Medicare contract. Enrollment in an HMO or HMO POS plan
from Indiana University Health Plans depends on the plan’s contract renewal with Medicare. IU Health
does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability,
genetic information, veteran status, national origin, gender identity and/or expression, marital status,
or any other characteristic protected by federal, state or local law. For language assistance, call
800.455.9776 (TTY/TDD 711 or 800.743.3333).
H7220_IUHMA2147a_M Accepted 8.2.2020 7Explanation of your vision care benefits (continued)
Choice HMO POS plan
Vision care services In-network member cost Out-of-network
reimbursement
Exam with dilation as necessary $0 copay Up to $30
Frames $150 allowance for frame, lens and lens Up to $75
options; 20% off balance over $150
Contact lenses
(Contact lens allowance includes
materials only.)
Conventional $0 copay, $150 allowance, 15% off Up to $120
balance over $150
Disposable $0 copay, $150 allowance, plus balance Up to $120
over $150
Medically necessary $0 copay, paid in full Up to $210
Laser vision correction 15% off the retail price or 5% off the N/A
LASIK or PRK from U.S. Laser Network promotional price
Additional pairs discount Members also receive a 40% discount off N/A
complete pair eyeglass purchase and
15% off conventional contact lenses once
the funded benefit has been used.
Frequency $150 max allowance
Examination Once every 12 months
Frames and lenses or contact lenses Once every 24 months
You’re on the INSIGHT network. For a complete list of providers near you, use our Enhanced Provider
Locator on Eyemedvisioncare.com/iuhealth or call 866.804.0982. For LASIK providers, call 877.5LASER6.
Benefits are not provided from services or materials arising from: orthopic or vision training, subnormal
vision aids and any associated supplemental testing; aniseikonic lenses, medical and/or surgical
treatment of the eye, eyes or supporting structures; any vision examination, or any corrective eyewear
required by a policyholder as a condition of employment; safety eyewear; services provided as a result
of any workers’ compensation law, or similar legislation, or required by any governmental agency or
program whether federal, state or subdivisions thereof; plano (non-prescription) lenses; non-prescription
sunglasses; two pair of glasses in lieu of bifocals; services or materials provided by any other group
benefit plan providing vision care; services rendered after the date an insured person ceases to be
covered under the policy, except when vision materials ordered before coverage ended are delivered,
and the services rendered to the insured person are within 31 days from the date of such order. Lost
or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit
frequency when vision materials would next become available. Benefits may not be combined with any
discount, promotional offering or other group benefit plans. Standard/premium progressive lens not
covered—fund as a bifocal lens. Standard progressive lens covered—fund premium progressive as a
standard. Benefit allowance provides no remaining balance for future use with the same benefits year.
Fees charged for a non-insured benefit must be paid in full to the provider. Such fees or materials are
not covered.
8Enjoy better hearing
and comprehensive care
Good hearing is important to your health. That’s
why IU Health Plans Medicare Advantage plans
offer you a hearing aid benefit through TruHearing®.
Hearing aids can be expensive—an average
of $2,700 per aid1—but your benefit makes
addressing hearing loss more affordable with
copayments of $999 or less.
2021 Hearing aid coverage
Your plan covers up to two hearing aids per year.
*
Routine exam
Your plan:
32 channels x 6 programs 48 channels x 6 programs In network2
Retail: $2,445/aid Retail: $3,125/aid
Select HMO and Select Plus $699 $999 $0
HMO 001, 002, 003 copay/aid copay/aid exam copay
$599 $899 $0
Choice HMO POS copay/aid copay/aid exam copay
*
Rechargeable battery option is available on the TruHearing Premium RIC Li, Slim RIC Li, Standard BTI Li,
and CROS Li styles for an additional $50 per hearing aid. Slim RIC Li only available with rechargeable
upgrade.
Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment
in an HMO or HMO POS plan from Indiana University Health Plans depends on the plan’s contract renewal
with Medicare.
Call TruHearing to learn more and schedule an appointment x Hours: 8 am – 8 pm, Monday – Friday
844.857.4333 x (TTY users call 711)
H7220_IUHMA2141a_M Accepted 8.1.2020 9Your comprehensive hearing benefit includes:
(See reverse for copayment details)
N
S
State-of-the-art technology Personalized care Help along your way
Experience the latest advances Receive expert care from our Get started on the journey to
in hearing technology team of helpful professionals better hearing with confidence
n Enjoy natural, lifelike sound in n Guidance and assistance from n A worry-free purchase with a
virtually all listening situations a TruHearing hearing consultant 45-day trial and 3-year warranty
n Hear speech clearly, even in n Local, professional care from an n 48 free batteries per aid included
noisy environments accredited provider in your area with non-rechargeable models
n Stream audio and phone calls n A hearing exam plus three n Guides to help you adapt
directly to your ears from your follow-up visits for fitting and to your new hearing aids at
smartphone3 adjustments TruHearing.com/GetStarted
Call TruHearing to verify your benefit and schedule a hearing exam x Hours: 8 am – 8 pm, Monday – Friday
844.857.4333 x (TTY users call 711)
1
Based on 2018 third-party survey of nationwide provider and manufacturer retail pricing.
2
Must be performed by a TruHearing network provider.
3
Smartphone compatible hearing aids connect directly to iPhone®, iPad® and iPod® Touch devices.
Connectivity also available to many Android® phones with use of an accessory.
TruHearing is an independent hearing aid program and network of providers utilized by IU Health Plans
Medicare Advantage HMO and HMO POS. This information is not a complete description of benefits.
Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits,
formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on
Jan. 1 of each year.
IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability,
genetic information, veteran status, national origin, gender identity and/or expression, marital status,
or any other characteristic protected by federal, state or local law. For language assistance, call
800.455.9776 (TTY/TDD 711 or 800.743.3333).
All content ©2020 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark of
TruHearing, Inc. All other trademarks, product names, and company names are the property of their
respective owners. Three follow-up visits must be used within one year after the date of initial purchase.
Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty
includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are
subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing hearing
consultant. IU_G_S_AEPF_0519
10We are excited to offer our IU Health Plans Medicare Advantage
®
members the Silver&Fit Healthy Aging & Exercise Program.
Through this program, you can improve your health and enjoy fitness center or YMCA
membership benefits. This program will provide you with:
n No-cost access to a participating fitness center or YMCA*
n Group fitness classes made for older adults (where offered) You choose how you want
n The option to work out at home by selecting one Stay Fit Kit to get healthy.
and up to two Home Fitness Kits from 34 unique options To learn more or for a list of
per benefit year fitness centers available through
n Healthy Aging classes four times a year (online or by DVD) the Silver&Fit® program, call
877.427.4788 (TTY/TDD: 711)
n A newsletter four times a year (online, by email or by mail)
Monday – Friday, 8 am – 9 pm, or
n The Silver&Fit Connected!™ tool, a fun and easy way to visit Silverandfit.com.
track exercise at a fitness center or through a wearable
fitness device or app and earn rewards**
n Other web tools like a fitness center search and online classes
*Non-standard services that call for an added fee are not part of the Silver&Fit® program.
**Rewards subject to change; purchase of a wearable fitness device or application may be required and
is not reimbursed by the Silver&Fit® program.
H7220_IUHMA2142_C 11Your use of the Silver&Fit Connected! tool serves as your consent for American Specialty Health
Fitness, Inc. (ASH Fitness) to receive information about your tracked activity and to use that data to
process and administer available rewards to you under the program. The Silver&Fit program is provided
by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health
Incorporated (ASH). All programs and services are not available in all areas. The people in this piece
are not Silver&Fit members. Silver&Fit, Silver&Fit Connected! and the Silver&Fit logo are trademarks
of ASH and used with permission herein. This information is not a complete description of benefits. Not
all YMCAs participate in the network. Members are advised to check the searchable directory on the
Silver&Fit website to see if their location participates in the program.
Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract.
Enrollment in an HMO or HMO POS plan from Indiana University Health Plans depends on the plan’s
contract renewal with Medicare.
For language assistance, call 800.455.9776 (TTY/TDD 711 or 800.743.3333).
IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability,
genetic information, veteran status, national origin, gender identity and/or expression, marital status, or
any other characteristic protected by federal, state or local law.
1213
H7220_IUHMA21213_C
14Healthy Rewards
Program
Earn rewards for receiving eligible health services between Jan. 1 – Dec. 31, 2021.
n $25 reward – Any member who completes one of the following: annual wellness visit, routine
physical exam* or “Welcome to Medicare” preventive visit in 2021.
n $25 reward – Members age 50 – 74 who complete a preventive annual breast cancer screening
mammography in 2021.
n $25 reward – $50 reward – Members age 50 – 75 who complete one colorectal cancer screening in
2021 are eligible to receive one reward. Talk to your provider about the test that is best for you:
– $25 reward – Complete one of the at-home screening tests. Eligible testing includes any one of the
following: FOBT, FIT or Cologuard®.
– $50 reward – Complete a preventive screening colonoscopy.
You will receive a Healthy Rewards Member Incentives card within 90 days after the first
qualifying eligible health service. You will need to:
1 Activate the card. Call 888.682.2400 or visit MyOTCCard.com.
2 Visit a participating retailer (Dollar General, Family Dollar, Walgreens, Walmart or CVS pharmacy).
Buy eligible over-the-counter (OTC) drugs and health-related products (excluding prescriptions).
Call 888.682.2400 or visit MyOTCCard.com to view covered items or check your card balance.
3 Swipe your card at a participating retailer to purchase eligible items up to your credit amount.
(You will be responsible for any costs over your credit amount.) Unused balances are carried over
to the next quarter and don’t expire until June 30, 2022.
4 Rewards for subsequent qualifying eligible health services will be applied to the card within 90
days of receiving the service.
*Tip: When receiving an annual routine physical exam, inform your primary care provider (PCP) that your
insurance covers that service at $0 copay so that you receive the desired service, and the claim is
submitted correctly.
H7220_IUHMA21214_C 15Cancer Resource Center
Taking care of the whole self.
The Cancer Resource Center at Indiana University Health Simon Cancer Center offers information
and education to help patients with cancer navigate through their cancer journey.
Our trained volunteers and staff can connect patients and families with information about
diagnosis and treatment, as well as community programs and support services to help with
day-to-day concerns and overall well-being.
Programs and services include: Visit us:
n Educational programming IU Health Simon Cancer Center
n Transportation services (Located on the first floor)
n Wig bank and fitting 1030 W. Michigan St.
n Support groups and counseling
Indianapolis, IN 46202
n Financial support T 317.944.0301
n Clinical trial matching
Hours:
n Community resources
n Lending library
Monday – Friday: 9 am to 5 pm
n IU Health CompleteLife therapy
programs
The Cancer Resource Center is a partnership between IU Health and five community cancer agencies.
H7220_IUHMA21215_C 16IU Health Plans wants to help
you take advantage of the health
screenings covered by Medicare.
My preventive health checklist – Use the checklist below to track preventive services and remember
to talk with your doctor about getting these important screenings. Take this chart with you to your next
doctor’s appointment.
All patients
Date
3
o Service
completed
How often do I need this service?
o Annual flu shot (everyone) Medicare will cover once each year.
Medicare will cover both vaccines a year
Pneumonia vaccine series
o (everyone age 65+)
apart. Talk with your doctor about which
vaccine(s) you need.
Glaucoma test Medicare will cover once each year if your
o (those at risk for glaucoma) doctor says you are at risk.
Mammogram*
o (women age 50 – 74)
Medicare will cover once every 12 months.
Colorectal cancer screening Medicare will cover the appropriate screening
o (everyone age 50 – 75) method as determined by your doctor.
Bone density screening
o (women age 65+)
Medicare will cover once every two years.
Medicare will cover one preventive visit
o Annual doctor visit (everyone)
each year.
*Women at increased risk for breast cancer due to family history and other factors may need to begin
screening earlier than age 50. Talk with your doctor about your risk and what is right for you.
Customer Solutions Center: 800.455.9776
(TTY/TDD 711 or 800.743.3333)
Oct. 1 to March 31, 8 am to 8 pm,
seven days a week; April 1 to Sept. 30,
8 am to 8 pm, Monday – Friday
iuhealthplans.org
Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract.
Enrollment in an HMO or HMO POS plan from Indiana University Health Plans depends on the plan’s
contract renewal with Medicare.
H7220_IUHMA21216_C 17For patients with diabetes
Date
3
o Service
completed
How often do I need this service?
o Hemoglobin A1C At least once each year
o Dilated eye exam At least once each year
o Kidney screening At least once each year
o Blood pressure check At least once each year
o Fasting blood glucose At least once each year
Medicare will cover three hours of
o Medical nutrition therapy one-on-one counseling services the first
year, if recommended by your doctor.
For patients with heart disease or high blood pressure
3 Date
o Service
completed
How often do I need this service?
o Hemoglobin A1C At least once each year
o Cholesterol At least once each year
o Blood pressure check At least once each year
You can only achieve good health and well-being through a conscious choice to pursue a healthy
lifestyle. Getting a preventive health screening is the first step to understanding your risk factors. You
may use the chart below to understand other lab tests that may be ordered. Know your numbers and
understand the desirable ranges. Take time to review your results. If you have any questions, discuss
them with your doctor.
Lab test reference chart*
Test Desirable range At risk
A1C Less than 5.7% 5.7% and above
Glucose 70 – 99 100 and above
Total cholesterol Less than 200 200 and above
Triglycerides Less than 150 151 and above
*Ranges may vary for those with certain medical conditions; discuss with your doctor what is best for you.
18950 N. Meridian St., Suite 400 Indianapolis, IN 46204-1202 iuhealthplans.org If you have questions, we’re here to help. Please call our Customer Solutions Center toll free at 800.455.9776; TTY/TDD 711 or 800.743.3333. Customer Solutions Center hours Oct. 1 – March 31; 8 am – 8 pm, seven days a week April 1 – Sept. 30; 8 am – 8 pm, Monday – Friday You may receive assistance through alternate technology after hours, on weekends and holidays. For language assistance, call 800.455.9776 (TTY/TDD 711 or 800.743.3333).
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