Presbyterian UltraFlex (HMO-POS)

Presbyterian Medicare Advantage plans combine safe ways to get care from home with many $0 and low-cost options, and $0 premium options, so you can get the care you need. Presbyterian offers you the value that comes with our integrated system of physicians, hospitals and health plan – all working together to keep you healthy.

With our HMO-POS plans, you receive more benefits than Original Medicare (Part A and Part B) and several valuable services for $0 copay.

Our $0 premium UltraFlex plan goes perfectly with your retirement plans. Your benefits include:

• A $360 flex card to help pay for approved over-the-counter products and out-of-pocket costs for dental, hearing and vision services

• No-cost primary care visits

• More telehealth providers with $0 telehealth visits with PCPs, specialists, and urgent care

• Some essential out-of-network benefits with a flat copay

• Dental, vision and hearing aid coverage

• Drug coverage with no deductible

• Routine acupuncture and chiropractic care

• Worldwide coverage for emergencies, urgent care and transportation

Providing You with the Benefits You Need

Flex Card Exclusively for UltraFlex Members

UltraFlex members receive a Flex card loaded with $90 per quarter to use for these out-of-pocket expenses:

• Hearing – Hearing aids and batteries or other hearing services. Save even more by using our TruHearing Hearing Aid benefit.

• Dental – Covered dental services including dental providers that accept VISA®.

• Vision – Frames, lenses and contacts, including contact lens fittings with any Medicare-approved vision providers that accept VISA®.

• Approved over-the-counter (OTC) health items – Non-prescription medications and other health-related items may be purchased online, at participating retail stores or through mail order. Retail stores include Dollar General, Walgreens, Walmart, Smith’s, CVS and many more.

Your balance carries over from quarter to quarter but does not carry over from year to year. A total of $90 per quarter can be used in any combination for eligible expenses, or the full $360 can be saved and used all at once at the end of the year. Members can check their account balance and find participating retail stores online by logging into myPRES at www.phs.org/myPRES or by calling a customer support phone number at

$0 Telehealth Benefit

Access that works for you anytime, anywhere.

Need to see your network Primary Care Provider or Specialist but don’t want to go into the clinic? There’s no charge for any visit over video, telephone or online with your network providers.

Telehealth options include visits with:

• Your Primary Care Provider

• Specialists

• Urgent Care

• Outpatient Rehabilitation Services

• Behavioral Health Providers

Dental Plans to Meet Your Needs

The UltraFlex plan includes basic preventative dental coverage through a contracted provider. An additional comprehensive option is available for a low monthly cost.

Enjoy Better Hearing

Good hearing is important to your overall health. That’s why we cover a routine annual hearing exam for no copay. The UltraFlex plan covers up to two hearing aids per year (one per ear per year).

Improve Your Fitness with Free SilverSneakers® Memberships

The SilverSneakers Fitness program is included at no additional cost to you. Visit more than 15,000 participating nationwide locations, including Planet Fitness, Anytime Fitness, Defined Fitness, Chuze Fitness, YMCA, and more.

Travel Worldwide and Be Protected with Assist America®

Enjoy the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year, for up to 90 days per emergency. This unique program immediately connects you to doctors, hospitals, pharmacies and other services when experiencing a medical emergency while traveling 100 miles or more away from your permanent residence or in another country.

Meals

Up to 30 meals delivered to your home during the four-week period following an inpatient hospital or skilled nursing stay. This benefit is offered through Meals on Wheels and coordinated by your discharge planner.

UltraFlex Eligibility and Enrollment

• You must be entitled to Medicare Part A and enrolled in Medicare Part B.

• You must live in one of these New Mexico counties:

  • Bernalillo

  • Cibola

  • Curry

  • Doña Ana

  • Lincoln

  • Rio Arriba

  • Sandoval

  • Santa Fe

  • Socorro

  • Torrance

  • Valencia

  • Quay