PHP, Georgia

Dr. Eugene Paul
AHF Provider

Medical Benefits and Costs

Next year, PHP (HMO SNP) is changing coverage for the medical services listed below. The information below describes these changes. For more details about the coverage and costs for these services, see Chapter 4, Medical Benefits Chart (what is covered and what you pay), in your 2020 Evidence of Coverage.

Benefit

2019 (this year)

2020 (next year)

Dental Services Limited dental services (this does not include services in connection with care, treatment, filling removal or replacement of teeth): You pay $0 copay.

 

Preventive dental services:

  • Cleaning (for up to 2 every year): You pay $0 copay.
  • Dental x-ray(s) (for up to 1 every year): You pay $0 copay.
  • Fluoride treatment (for up to 2 every year): You pay $0 copay.

Oral exam: You pay $0 copay.

Comprehensive dental services such as the following: You pay $0 copay.

  • Non-routine services
  • Diagnostic services
  • Restorative services
  • Endodontics/
    periodontics/
    extractions
  • Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental services are limited to $1,050 every year.

Limited dental services (this does not include services in connection with care, treatment, filling removal or replacement of teeth): You pay $0 copay.

 

Preventive dental services:

  • Cleaning (for up to 2 every year): You pay $0 copay.
  • Dental x-ray(s) (for up to 1 every year): You pay $0 copay.
  • Fluoride treatment (for up to 2 every year): You pay $0 copay.

Oral exam: You pay $0 copay.

Comprehensive dental services such as the following: You pay $0 copay.

  • Non-routine services
  • Diagnostic services
  • Restorative services
  • Endodontics/
    periodontics/
    extractions
  • Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental services are limited to $1,200 every year.


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H3572_4006 101519_2020