Evidence of Coverage Errata Sheet - Mercy Care Plan

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On page 15, of Chapter 2, underthe section titled “How to contactus when you are making anappeal about your Part Dprescription drugs,” the title ofthe first table is incorrect.Incorrect Title: CoverageDecisions for Medical CareCorrect Title: Appeals forPart D Prescription DrugsOn page 36, of Chapter 4, the“Section 1.3 header is printedtwice on the page.On page 38, of Chapter 4, in theBenefits chart, under “Servicesthat are Covered for You,” the“Annual Wellness Visit” benefitinformation is missing.Duplicated text: “Section1.3 What is the most youwill pay for Medicare PartA and Part B coveredmedical services?”Missing “Annual WellnessVisit” benefit information.This section should haveonly printed once on page36.Annual Wellness VisitServices that are covered foryou:If you’ve had Part B forlonger than 12 months, youcan get an annual wellnessvisit to develop or update apersonalized prevention planbased on your current healthand risk factors. This iscovered once every 12months.Note: Your first annualwellness visit can’t takeplace within 12 months ofyour “Welcome toMedicare” preventive visit.However, you don’t need tohave had a “Welcome toMedicare” visit to becovered for annual wellnessvisits after you’ve had Part Bfor 12 months.What you must pay whenyou get these services:There is no coinsurance,copayment, or deductible forthe annual wellness visit.
On page 39, of Chapter 4, in theBenefits chart, under “Servicesthat are Covered for You,” the“Bone mass measurement”benefit information is missing.Missing “Bone massmeasurement” benefitinformation.Bone mass measurementServices that are covered foryou:For qualified individuals(generally, this means peopleat risk of losing bone mass orat risk of osteoporosis), thefollowing services arecovered every 24 months ormore frequently if medicallynecessary: procedures toidentify bone mass, detectbone loss, or determine bonequality, including aphysician’s interpretation ofthe results.What you must pay whenyou get these services$0 copay for all preventiveservices covered underOriginal Medicare at zerocost sharing.Any additional preventiveservices approved byMedicare mid-year will becovered by the plan or byOriginal Medicare.On page 40, of Chapter 4, in theBenefits chart, under“Chiropractic services,” the word“chiropractic” is missing from the“What you must pay when youget these services” column andthe prior authorization statementis missing.0% or 20% of the cost foreach Medicare coveredvisit.*Missing PriorAuthorization may apply0% or 20% of the cost foreach Medicare coveredchiropractic visit.*Prior Authorization mayapply.
Page 1: Errata Sheet to theMercy Care Advan
Page 5 and 6: On page 92, of Chapter 6, under“S

Evidence of Coverage Errata Sheet - Mercy Care Plan

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