¹Some services require prior authorization (PA). Our network providers know what we cover under your benefit plan. They also know what requires prior authorization and will request approval from Health New England on your behalf. For a complete list of services that require prior authorization, refer to the summary of benefits.

²PA after visit 25 or if services are rendered in a SNF as an outpatient benefit when member is a resident of the SNF.

³Health New England additional benefits include allowances that must be used within the one or two calendar year period, as well as other additional benefits. Refer to the Summary of Benefits or call Member Services if you have questions about what items and services are covered.

⁴You must see a TruHearing® provider to use this benefit. Other providers are available in our network. Please note, hearing aids purchased through other providers are not covered.

⁵Mail-order: During the coverage gap stage, for the Health New England Premium (HMO) plan, preferred generics are covered at $8 for a three month supply. Non-preferred generics are covered at 44%, and Preferred and Non-Preferred Brands are covered at 35% of the price or the Health New England negotiated price, whichever is lower. For the Plus plan and the Value plan, standard coverage gap cost-sharing applies. During the catastrophic coverage stage, standard catastrophic coverage applies for all plans.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.