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MPHCampusMap2022

BayCarePlus
Complete (HMO)
BayCarePlus
Premier (HMO)
Diabetes Benefits
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$25/Quarter +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to four routine visits/calendar year, which include nail trimmings $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for four additional hours/calendar year $0 Copay for six additional hours/calendar year
Diabetes Benefits
BayCarePlus
Complete (HMO)
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$25/Quarter
Enhanced Podiatry Benefit $0 Copay for up to four routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for four additional hours/calendar year
BayCarePlus
Premier (HMO)
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year
BayCarePlus
Complete (HMO)
BayCarePlus
Premier (HMO)
Diabetes Benefits
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$25/Quarter +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to four routine visits/calendar year, which include nail trimmings $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for four additional hours/calendar year $0 Copay for six additional hours/calendar year
Diabetes Benefits
BayCarePlus
Complete (HMO)
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$25/Quarter
Enhanced Podiatry Benefit $0 Copay for up to four routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for four additional hours/calendar year
BayCarePlus
Premier (HMO)
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year
Insulin $0-$35 Copay per month
*remains through the coverage gap
Diabetes Supplies $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Additional Over-the-Counter (OTC) Dollars +$50/Quarter
Enhanced Podiatry Benefit $0 Copay for up to six routine visits/calendar year, which include nail trimmings
Extra Nutrition Counseling $0 Copay for six additional hours/calendar year

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