2022 Flex (RPPO) Plan
Generations Advantage Flex (RPPO) is designed for those looking for a health care plan with more flexibility. With this plan, you get complete medical, hospital, and Part D Prescription Drug coverage and you can see out-of-network doctors for all covered medical services, though you pay less for in-network and in-service-area doctors. The Flex plan is available throughout the service area of Maine and New Hampshire.
Your Area
Flex Benefits
Costs
- Please enter your Zip Code above to see your plan premium.
*Note: This is not a comprehensive list of plan benefits, please refer to the Evidence of Coverage (EOC) for a full list of plan benefits.
Features
- Part D Prescription Drug coverage (see if your drugs are covered for 2022)
- Emergency and Urgent care coverage worldwide
- Large network of doctors across Maine and New Hampshire (see if your doctor is in-network)
- Out-of-network flexibility: option of getting all services outside the network, but you will generally pay more for these services2
- Over-the-counter (OTC): Up to $50 quarterly for members to purchase select CVS-brand, over-the-counter items
- Wellness Wallet: Up to $200 reimbursed each year in total for eyewear, face masks, dietary/nutrition, fitness benefit, naturopathic services, acupuncture, and weight management programs (see what's covered)
- Hearing aids: $495/$695/$1,095/$1,495/$2,095 copay per ear, depending on tier selected (no copays for fittings or evaluations)
- Flu shots: Get your annual flu shot3 at no cost, either at your primary care provider’s office (who may charge an office visit copay) or a participating pharmacy.4
Comprehensive Dental Benefits
- No waiting periods for coverage
- $50 office visit copay
- $1,000 benefit maximum (in- and out-of-network combined)
- In-Network: See a dentist in the Delta Dental network.
- Out-of-Network: See any out-of-network dentist, cost shares differ.
- Diagnostic and preventive services include cleanings, exams, and X-rays: In-network—fully covered with no coinsurance/deductible; Out-of-network—covered at 50% with no deductible.
- Basic restorative services include fillings, oral surgery, root canals, and periodontal maintenance: In-network—covered with 50% coinsurance and a one-time $50 deductible; Out-of-network—covered with 75% coinsurance and a one-time $50 deductible.
- Major restorative services include dentures, bridges, crowns, onlays, and implants: In-network—covered with 50% coinsurance and a one-time $50 deductible; Out-of-network—covered at 75% coinsurance and a one-time $50 deductible.
Part D Prescription Drug Copayments
$275 Prescription deductible for Tiers 3–5 drugs only
| Tier | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
| Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* | $2 | $10 | $40 | $95 | 28% of cost |
| Pharmacies with Standard cost sharing, 30-day supply* | $4 | $18 | $47 | $100 | 28% of cost |
| Mail-order, 90-day supply | $0 | $20 | $100 | $237.50 | 28% of cost |
Open Enrollment Begins October 15
Request your 2022 Medicare Guide to learn more about our plans and discover how a Generations Advantage plan can help you live your best life.
1At pharmacies with preferred cost-sharing, you pay $2 for Cost-Sharing Tier 1 (preferred generic drugs and certain preferred brand name drugs). Other pharmacies are available in our network.
2Out-of-network/non-contracted providers are under no obligation to treat Flex plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
3Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Flex and costs do not count toward your Part D drug spend or out-of-pocket costs.
4The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.
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The materials on this page may be made available in other formats such as Braille, large print or other alternate formats. Please contact us for more information. Call Member Services at 1-866-544-7504 (TTY:711).
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2Out-of-network/non-contracted providers are under no obligation to treat Flex plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
3Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Flex and costs do not count toward your Part D drug spend or out-of-pocket costs.
4The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.
You may download Adobe Reader free to view the PDF documents.
The materials on this page may be made available in other formats such as Braille, large print or other alternate formats. Please contact us for more information. Call Member Services at 1-866-544-7504 (TTY:711).
View Disclaimers