The UniCare State Indemnity Plan/Medicare Extension (OME) is a supplemental Medicare plan offering access to any licensed doctor or hospital throughout the United States. The mental health benefits of this plan, administered by Beacon Health Options, offer you in-network benefits with a copay. Or, you may seek care out-of-network, but at higher out-of-pocket costs. Prescription drug benefits are administered by SilverScript.
Plan Contact Information
Contact the plan for additional benefit information.
Mental Health, Substance Abuse and EAP Benefits:
Beacon Health Options 1-855-750-8980
Prescription Drug Benefits
1.877.876.7214 TDD: 1-800-238-0756
Copays with CIC (Comprehensive) Effective July 1, 2016
(Without CIC, deductibles are higher and coverage is only 80% for some services. Contact the plan for details.)
Calendar Year Deductible $35 per person
Physician Office Visit
Covered at 100% - no copay
Network Outpatient Mental Health and Substance Abuse Care (See the Attached Beacon OME Grid for additional benefit details.)
First four visits $0; visits 5 and over: $10 per visit
Beacon also offers EAP services.
Inpatient Hospital Care (Maximum one copay per person per calendar year quarter)
$50 per admission
Inpatient and Outpatient Surgery
Covered at 100% - No copay - in Massachusetts and for out-of-state providers who accept medicare, call the plan for details if using out-of-state providers who do not accept medicare.
$25 per visit (waived if admitted)
Retail up to 30 day supply: Mail Order up to 90-day supply:
Tier 1: $10 Tier 1: $25
Tier 2: $30 Tier 2: $75
Tier 3: $65 Tier 3: $165
Who is Eligible?
Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents with Medicare Part A and Part B are eligible.
Where You Live Determines Which Plan You May Enroll In:
The UniCare State Indemnity Plan/Medicare Extension (OME) is available throughout the United States.
FY16 UniCare State Indemnity Plan/Medicare Extension handbook file size 1MB - series 2
This information provided by the Group Insurance Commission .