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PFFS Terms and Conditions of Payment
 
 
Tufts Medicare Preferred PPO: Medical Benefit
Tufts Medicare Preferred PPO offers flexibility and choice of doctor. If you receive services from Tufts Medicare Preferred PPO plan providers, your costs will be less than if you receive services from non-plan providers with the exception of Emergency and Urgent care.

The comparison chart below gives you a brief overview of Tufts Medicare Preferred PPO benefits and costs. For a more detailed description of plan benefits and costs, see the Tufts Medicare Preferred PPO Summary of Benefits booklet. Once you have compared the Medical benefits click on 'prescription benefit' on the menu to the left, to compare your prescription drug options.

Click on Step 2 to Select Your Prescription Drug Plan.
 
 
Plan Co-Payments* Plan Providers Non-Plan Providers
Doctor's Office Visits $15 $30
Specialist's Office Visits $20 $30
Inpatient General Hospital Coverage $100/day for day(s) 1-5;
After Day 5: $ 0 co-payment
$750/each admission
Worldwide Emergency Coverage $50 $50
Maximum Out-Of-Pocket Costs (per calendar year) $3,350 $3,350
Vision Services $20 co-payment for one routine eye exam per year;
$150 toward eyewear every year
$30 co-payment for one routine eye exam per year;
$150 toward eyewear every year
Hearing Services $20 co-payment for one routine hearing test per year $30 co-payment for one routine hearing test per year
Annual Fitness Beneft
$150 toward fitness club membership per year
 
*Exclusions and limitations apply.


H2229-2009-15 9/30/08
This document was last modified: 9/30/08
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