2018 Supplemental Benefits
Clover plans provide all the benefits of Original Medicare, plus access to supplemental benefits that members use to get quality care and services. We partner with national providers to offer dental, vision, hearing, fitness, and telemedicine benefits that supplement Medicare-covered or diagnostic services. Refer to your plan's Evidence of Coverage (EOC) for specific services and costs.
Quality dental care is an essential part of your overall health. Clover has partnered with DentaQuest to offer routine dental exams and services.
Supplemental dental benefits include:
- Two Oral Exams per year, $0 copayment
- Two Teeth Cleanings per year, $0 copayment
- One Dental X-Ray per year, $0 copayment
For Medicare-covered dental services, like diseases or injuries that are treated in a hospital, refer to your Evidence of Coverage.
DentaQuest is a nationwide network of dentists committed to high-quality dental care. Seeing an in-network dentist is the easiest way to take advantage of your $0 copay. Just present your card at the time of service for the routine dental visit.
Before you see an out-of-network dentist for your care, ask your provider for a cost estimate. Then call Clover Customer Experience to understand your share of the cost. If you do go out of network, your dentist will need to submit a claim directly to DentaQuest. We will reimburse your dentist up to the allowed amount under your plan; however, you may be responsible for any balance above the allowed amount.
If your out-of-network provider needs to submit a claim to DentaQuest, have them mail or fax the claim and a copy of your Clover member ID card to:
PO Box 2906
Milwaukee, WI 53201-2906
Clover covers one routine vision exam per year and provides a yearly allowance for eyeglass frames, lenses, or contact lenses through EyeQuest. Your Clover plan also cover medical vision care, such as diabetic retinal exams, cataract surgeries, and other treatments that fall under your medical benefits. For more information, see your Evidence of Coverage or call us at 1-888-778-1478 (TTY 711).
In-network eye care
Your Clover plan covers one routine vision exam per year. An EyeQuest provider will perform your routine exam for a fixed copay. Just present your Clover card at the time of service, and be sure your appointment is for a routine exam.
Out-of-network eye care
If you choose to go out of network for your routine vision exam, you will need to pay up-front and submit a claim or have your provider submit a claim for you to EyeQuest. You will be reimbursed up to the allowed amount under your plan; however, you may be responsible for any balance above the allowed amount.
If your out-of-network provider needs to submit a claim to EyeQuest, have them mail or fax the claim and a copy of your Clover member ID card to:
EyeQuest Attn: Vision Claims Processing
PO Box 433
Milwaukee, WI 53201-0433
Glasses and contacts
Need a cooler set of glasses, some new lenses, or contacts? Your plan includes an annual allowance for everyday eye wear through EyeQuest or at other retail locations. We’ll reimburse you up to the amount your plan covers.
How much you pay for glasses or contacts depends on the cost of the eyewear you choose. The following are examples only, to show you how your share of the cost is calculated. Your actual benefits may be different; refer to your Evidence of Coverage for details.
If your plan has a $20 copay for eyewear and covers up to $100, and you choose glasses that cost $95
- You pay the $20 copay Clover pays: $75 up to the total cost of the glasses
- Total cost: $75 + $20 = $95 cost of the glasses
If your plan has a $20 copay for eyewear and covers up to $100, and you choose contact lenses that cost $200
- You pay the $20 copay
- Clover pays: $100, up to the benefit maximum. This still leaves a $80 balance on the eyewear you picked.
- You pay the $80 remaining balance in addition to your copay
- Total cost: $100 + $20 + $80 = $200 cost of the contact lenses
Original Medicare doesn't cover routine hearing services, but your Clover plan does. We believe in treating hearing loss early. Clover works with TruHearing to provide hearing aid services at a low cost: one Routine Hearing Exam per year, two hearing aids, and three provider visits within the first year of receiving your aid. Supplemental hearing benefits include the following services and cost-shares:
- One Routine Hearing Exam per year with a TruHearing provider, $0 copayment
- Two TruHearing hearing aids per year, one for each ear:
- Flyte Advanced aid, $699 copayment for each hearing aid, or;
- Flyte Premium aid, $999 copayment for each hearing aid
- Three TruHearing Provider Visits within the first year of the hearing aid purchase,
- 45-day trial period, 3-year extended warranty, and 48 batteries per aid
All Clover members receive access to Silver Sneakers, a program that offers members free access to a network of gyms. Silver Sneakers' gyms offer activities like recreational swimming, aerobics, weight management services, nutrition counseling, and individualized fitness programs.
Teladoc is Clover's partner for telemedicine services. With Teladoc, you can arrange to speak with a board-certified doctor or mental health professional by phone or video from the comfort of your home. Teladoc providers can treat your minor symptoms, like cold, flu, allergies, infections; or mild to moderate behavioral health concerns. Teladoc doesn't replace your relationship with your Primary Care Provider (PCP), and we encourage you to coordinate use of Teladoc with the care for serious or chronic conditions that you receive from your regular care team. If you are experiencing a medical emergency, call 911 and do not call Teladoc.
Through Clover’s Hello to Healthy rewards program, you can earn complimentary gift cards from your favorite stores for things like getting a flu shot or scheduling an annual Clover Care visit. We’ll also remind you when you’re due for an annual checkup, certain routine screenings, and other points of interest on your wellness journey. It’s an easy way to get the most out of your plan benefits throughout the year. You should receive more information in the mail about this program in the beginning months of each year.