Coverage And Benefits

Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.

Important Information about your Part D Vaccine and Insulin Coverage

What You Pay for Vaccines – Our plan covers most adult Part D vaccines at no cost to you.

What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan. Refer to your plan materials.

ARBenefits Group Medicare Advantage (PPO)

2024 materials

Retired Arkansas State Employees (ASE)

Retired Public School Employees (PSE)

National PPO plan coverage overview

A national plan covering all eligible beneficiaries regardless of where they reside in the U.S., D.C. and 5 U.S. territories
Visit doctors, specialists and hospitals in or out of our network for the same cost share as long as the provider participates in Medicare and accepts the plan and have not opted out of or been excluded from Medicare
Routine dental, vision, hearing, chiropractic, acupuncture and podiatry coverage
No referral needed to see a specialist
Routine hearing aid and eyewear allowances
Prescription drug coverage with no donut hole
Additional features such as a free gym membership and more

Benefits and costs

Plan options and costs
Benefits	ARBenefits Group Medicare Advantage (PPO)
ARBenefits Group Medicare Advantage (PPO)
Annual medical deductible	$0
Annual medical deductible
$0
Annual out-of-pocket maximum	$0
Annual out-of-pocket maximum
$0
Office and clinic visits	$0 copay for primary care $0 copay for specialist visit
Office and clinic visits
$0 copay for primary care $0 copay for specialist visit
Hospital services (inpatient)	$0 copay
Hospital services (inpatient)
$0 copay
Hospital services (outpatient)	$0 copay
Hospital services (outpatient)
$0 copay
Prescription drug coverage	Retail (31-day supply) Tier 1: Generic $15 copay Tier 2: Preferred Brand $40 copay Tier 3: Non-Preferred Brand $80 copay Tier 4: Specialty Tier $100 copay Mail order (93-day supply) Tier 1: Generic $30 copay Tier 2: Preferred Brand $80 copay Tier 3: Non-Preferred Brand $160 copay Tier 4: Specialty Tier $200 copay Rx maximum out-of-pocket: $3,100
Prescription drug coverage
Retail (31-day supply) Tier 1: Generic $15 copay Tier 2: Preferred Brand $40 copay Tier 3: Non-Preferred Brand $80 copay Tier 4: Specialty Tier $100 copay Mail order (93-day supply) Tier 1: Generic $30 copay Tier 2: Preferred Brand $80 copay Tier 3: Non-Preferred Brand $160 copay Tier 4: Specialty Tier $200 copay Rx maximum out-of-pocket: $3,100

Preventive services

The following preventive services are covered under your plan for a $0 copay when you visit your primary care physician:

Screening and counseling to reduce alcohol misuse
Screening for depression in adults
Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral counseling to prevent STIs
Intensive behavioral therapy to reduce cardiovascular disease risk
Screening and counseling for obesity

For more information about these preventive services, please call the Customer Service number on your plan ID card.

Disclaimer

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.