Perks, Programs, and More
Medicare not including dental, hearing, or vision? That was the old way. Now there’s a new way. Simplete includes these benefits and more with all Medicare Advantage plans.
Vision Coverage
Get access to vision services beyond what Original Medicare covers, including a routine vision exam with an in-network provider. Plus, get a $150 allowance for eyewear.
Comprehensive Dental
Simplete Medicare Advantage members get $2,000 each year for services Original Medicare doesn’t cover. Your dentist can submit a claim for you directly to us using the claims information on the back of your member ID card. There’s no set network, so you can go to any dentist you choose.
Simplete plans include all Medicare-covered dental services but also offer non-Medicare-covered dental services as well. These additional benefits include but are not limited to:
- Oral exams.
- Cleanings.
- X-rays.
- Fluoride treatments.
- Fillings.
- Dentures.
- Denture adjustments and repairs.
- Crowns.
- Treatments for gum disease.
- Bridge work.
- Root canals and extractions.
You may have a copay or coinsurance for some dental services. Check your Summary of Benefits.
Hearing Benefits
Through TruHearing®, you can get one routine hearing exam for a $0 copay and lowered rates on up to two TruHearing hearing aids per year when you see a TruHearing provider.
Acupuncture
Your plan is made with acupuncture coverage beyond what Original Medicare covers to give you more access to treatment when you need it.
- Treatment must be for headache, neck pain or lower back pain diagnoses.
- You don’t need prior authorization.
- You can choose any acupuncture provider.
- A per-visit copay may apply (varies by plan).
- You or your provider should submit claims using the information on the back of your ID card.
You get access to up to 15 covered visits for headache and neck pain. Coverage for lower back pain treatment includes 12 initial visits with eight additional visits if you’re showing improvement through treatment. Lower back pain visits are limited to 20 per year.
For more information, see your Evidence of Coverage or call the Member Services number on the back of your ID card.
Free In-Network Preventive Care
At no additional cost to you, Simplete plans cover many preventive services, including:
- Annual wellness visits.
- Routine cancer screenings (including mammograms and colonoscopies).
- Cardiovascular disease risk-reduction visits.
- Flu shots.
- Bone mass measurements.
- Depression, diabetes and HIV screenings.
- Hepatitis B and pneumococcal shots.
- Medical nutrition therapy.
- Obesity screening and therapy.
- Screening and counseling to reduce alcohol misuse.
- Screening for sexually transmitted infections (STIs) and counseling to prevent STIs.
- Counseling to stop smoking or tobacco use.
- "Welcome to Medicare" preventive visit (one time).
Nurse Advice Line
Get 24/7 answers to your health questions, like whether you need to set up an appointment or see a doctor right away.
Virtual Health Coverage
Get care when and where you need it with virtual health coverage. If you need to interact with your primary care provider (PCP) or specialist over the phone or online, you’re covered through the telehealth benefit. You don’t even need to leave the comfort of your home.
You can also get care for common conditions like allergies, cold, flu and pink eye from anywhere you have phone or internet connection in the U.S. Whether at home or traveling, you can talk to a board certified doctor or counselor by phone or secure video through hally.com at any time of the day, any day of the year.
Be Fit Fitness Benefit
With our Be Fit program, you get a free membership to Riverside Health Fitness Center or a reimbursement of up to $360 a year for a variety of fitness activities, like the following and more:
- Fitness class fees.
- Gym memberships.
- Online fitness subscriptions.
- Weight loss subscriptions.
- Ski memberships.
- Rowing.
- Golf.
- Bowling.
- Tennis.
- Pickleball.
- Recreational league fees.
- Pool exercise classes.
- 5K/10K race fees.
If your fees are more than $360 a year, you pay the difference. If they’re less, we pay you back the amount you paid. Be Fit doesn’t cover fitness trackers or personal equipment.
Wellness Rewards
Take steps toward better health while working your way toward a $50 gift card. Have a yearly wellness visit or physical, plus complete two other activities outlined at simplete.org/perks to qualify for your $50 gift card.
Quit For Life®
Quitting tobacco is one of the biggest positive impacts you can make on your health. That's why we offer the Quit For Life program - the nation's leading tobacco-cessation program. This service helps you quit for good by using:
- One-on-one coaching from a quit coach.
- A personalized quit plan.
- Helpful tools, like Text2Quit®.
- Web Coach®, an online learning and support community.
Assist America
When you travel 100 miles or more from home, Simplete Medicare Advantage members have access to Assist America®*, a global emergency service that’s ready to help if you have an immediate health need. Assist America can connect you to prompt, reliable medical attention, as well as some non-medical services, as needed. Here are just some of the services that are included:
- Prescription assistance if you need medication or left your prescription behind.
- Medical referrals.
- Emergency medical evacuation.
- Help returning home if you need medical care.
- Lost luggage assistance.
- Interpreter and legal referrals.
*Members may have additional costs related to travel services.
All Assist America benefits apply on all of our Medicare Advantage plans, but when you’re out of network, our HMO plans cover only emergency and urgent care. Assist America will not pay you back for ambulance and other services you arrange on your own. In a life-threatening emergency, always call the ambulance right away. There is no added cost for the service itself, but there could still be a cost with any medical care. Other conditions and exclusions may apply.