533 Medicare Advantage Plans from UnitedHealthcare. Coverage varies by plan. Select a Medicare Advantage Plan below to view details about the coverage it provides: Plan CodePlan Name. H0271:007-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:012-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:017-0 UnitedHealthcare Medicare ...Sep 1, 2023 · What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. Thermal Conductivity Btu/ sq ft/ ft hr/ °F at 68°F. 17. Coefficient of Thermal Expansion 68-572 10 to -6 power per °F (68 – 572°F) 9. Specific Heat Capacity Btu/ lb /°F at 68°F. 0.09. Modulus of Elasticity in Tension ksi. 22000. Modulus of Rigidity ksi. Y0066_SB_H0271_060_002_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... UnitedHealthcare Dual Complete® Choice (PPO D-SNP) dummy spacing Benefits In-Network Out-of-Network Inpatient Hospital Care2 $0 copay - $1,556 copay per stay 40% coinsurance perY0066_SB_H0271_023_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Sus Beneficios y Servicios de Salud y su Cobertura de MedicameWe would like to show you a description here but the site won’t allow us. 5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educated 2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758Z o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ FemeninoJan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond counties Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de CoberturaNumber of Members enrolled in this plan in (H0271 - 036): 2,359 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberOMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Sus Beneficios y Servicios de Salud y su Cobertura de Medicame CSNY23PP0049825_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul)Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage UnitedHealthcare - H0271 For 2023, UnitedHealthcare - H0271 received the following Star Ratings from Medicare: Overall Star Rating: 4 stars Health Services Rating: 3.5 stars Drug Services Rating: 3 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ...Call us: Call UnitedHealthcare at 1-877-596-3258 / TTY 711, 8 a.m. to 8 p.m. 7 days a week. 1 $0 cost-share for in-network dental care, specified services only. If your plan offers out-of-network dental coverage and you see an out-of-network dentist you might be billed more, even for services listed as $0 copay.Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queUnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium.Y0066_EOC_H0271_060_002_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de CoberturaNumber of Members enrolled in this plan in (H0271 - 057): 3,821 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined.Y0066_EOC_H0271_060_001_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-002This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 2 available in Select Counties Downstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.UnitedHealthcare - H0271 En el año 2023, UnitedHealthcare - H0271 recibió las siguientes Calificaciones con Estrellas de Medicare: Calificación General por Estrellas: 4 estrellas Calificación de los Servicios de Salud: 3.5 estrellas Calificación de los Servicios de Medicamentos: 3 estrellas UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium. We would like to show you a description here but the site won’t allow us.Sep 1, 2023 · What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. h0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Monday – Friday 8 a.m. – 6 p.m. EST 1-888-617-8979 TTY 711. To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP NeitherEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond counties Number of Members enrolled in this plan in (H0271 - 036): 2,359 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-002o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number Y0066_SB_H0271_023_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Medical Plans. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc.License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc ...Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ... Plan ID: H0271-060-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ...OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Sus Beneficios y Servicios de Salud y su Cobertura de Medicame OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Sus Beneficios y Servicios de Salud y su Cobertura de Medicame Jan 1, 2023 · Y0066_SB_H0271_013_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... 5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educatedCall (518) 346-2115 for Medicare Advantage, Supplement & Part D Plans in NY MA NJ or FLJan 1, 2023 · Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ FemeninoUnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-002 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. 533 Medicare Advantage Plans from UnitedHealthcare. Coverage varies by plan. Select a Medicare Advantage Plan below to view details about the coverage it provides: Plan CodePlan Name. H0271:007-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:012-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:017-0 UnitedHealthcare Medicare ...Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Sep 1, 2023 · What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Lookup Tools plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-0022023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Essex, New York Click to see other locations. Plan ID: H0271 - 060 - 1 Click to see other plans. Member Services: 1-800-514-4912 TTY users 711. Number of Members enrolled in this plan in (H0271 - 036): 2,359 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Área de servicio: New York - condados de Albany, Allegany, Broome, Cattaraugus, Cayuga,Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que Jan 1, 2023 · h0271-060-001 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-002Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 plan for New York. Check eligibility, explore benefits, and enroll today. Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Coberturao UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberY0066_EOC_H0271_060_001_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002 Subject UnitedHealthcare Dual Complete additional benefit overview for health care professionals.Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...h0271 023 014 ct in me 020 028 mi 029 030 mt 016 sc 037 sd 038 ut 013 wv 042 wy 039 024 h0321 arizona physicians ipa, inc. az h0423 metroplus health plan, inc. h0432 009 h0439 cigna healthcare of georgia, inc. h0473 humana insurance company of kentucky h0482 centene venture company michigan h0524 kaiser foundation hp, inc. ca h0544 blue cross ...H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond countieso UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758Z o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number UnitedHealthcare - H0271 En el año 2023, UnitedHealthcare - H0271 recibió las siguientes Calificaciones con Estrellas de Medicare: Calificación General por Estrellas: 4 estrellas Calificación de los Servicios de Salud: 3.5 estrellas Calificación de los Servicios de Medicamentos: 3 estrellasY0066_SB_H0271_060_002_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... UnitedHealthcare Dual Complete® Choice (PPO D-SNP) dummy spacing Benefits In-Network Out-of-Network Inpatient Hospital Care2 $0 copay - $1,556 copay per stay 40% coinsurance perY0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Medical Plans. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc.License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc ...CSNY23PP0049826_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul)This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.
Plan ID: H0271-060-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ... . Shy gal vore
Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Área de servicio: New York - condados de Bronx, Kings, Nassau, New York, Queens y RichmondEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,Jan 1, 2023 · Y0066_SB_H0271_050_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Y0066_SB_H0271_016_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.Y0066_SB_H0271_060_001_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageY0066_EOC_H0271_060_002_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de CoberturaNumber of Members enrolled in this plan in (H0271 - 027): 4,053 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-002 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberY0066_SB_H0271_060_001_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... See full list on uhcprovider.com Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined..