Your Network Health Go PPO Comparison
Thank you for placing your trust and confidence in FHK to service your ongoing Medicare-related health insurance needs.
Customer Service: 800-378-5234
EyeMed link: EyeDocLocator.com
EyeMed Phone: 833-279-4359
Dental Network link: SayCheese
Dental Network Phone: 888-454-4127
TruHearing: 877-759-8131
Find A Doc: NetworkHealth.com
New Gym Membership Link: YourOnePass.com
Mail Order with Express Scripts: 800-316-3107
For a full listing of the Network Health GO PPO, please click here.
2024
2025
Go
Go
H5215-009
H5215-009
Southeastern
Southeastern
Premium
$0
$0
Part B Giveback
$0
$0
Primary Doctor
$0 / $30
$0 / $30
Specialist
$35 / $75
$50 / $100
Physical Therapy
$40 / $75
$50 / $100
Urgent Care
$45
$50
Hospital
$295 days 1-6
$295 days 1-6
OON
$550 days 1-7
$800 days 1-7
MOOP Cap
$3,900 / $6,500
$3,900 / $6,200
Outpatient Surg
$275 / $225 ASC / $450
$275 / $225 ASC / $550
Ambulance
$275
$275
Emergency
$110
$125
Lab Services
$0-$20 / $30
$0-$20 / $40
X-Rays
$35 / $45
$35 / $70
Complex Diag
$200 / $250
$275 / $550
DME
20% / 25%
20% / 25%
Chemo/Part B
20% / 50%
20% / 50%
Part D
$2 / $8 / $42 / $95
$2 /$8 / 24% / 37%
90 Day- Mailorder
$0 / $0 / $105 / $237
$0 / $0 / 24%/ 37%
Part D Ded
$195
$320
(applies to tiers 2,3,4,5)
(applies to tiers 2,3,4,5)
Skilled Nursing
$0 days 1-20
$203 days 21-45
$0 days 1-20
$214 days 21-45
Hearing Aid
$495 – $1,695
$495 – $1,695
OTC
Pick your Perks($1,525)
Pick your Perks($1,200)
Gym Membership
SilverSneakers
One Pass
Dental
Pick your Perks($1,525)
Pick your Perks($1,200)
Dental Rider
$42/mo $1,000
$45/mo $1,000
Dental Network
ANY/Delta Dental MA
ANY/Delta Dental MA
Vision
Pick your Perks($1,525)
Pick your Perks($1,200)
Your Network Health Go PPO Comparison
2024
2025
Go
Go
H5215-010
H5215-010
Southeastern
Southeastern
Premium
$0
$0
Part B Giveback
$0
$0
Primary Doctor
$0 / $30
$0 / $30
Specialist
$35 / $75
$50 / $100
Physical Therapy
$40 / $75
$50 / $100
Urgent Care
$45
$50
Hospital
$295
days 1-6
$295
days 1-6
OON
$550
days 1-7
$800
days 1-7
MOOP Cap
$3,900 / $6,500
$3,900 / $6,200
Outpatient Surg
$275 / $225 ASC / $450
$275 / $225 ASC / $550
Ambulance
$275
$275
Emergency
$110
$125
Lab Services
$0-$20 / $30
$0-$20 / $30
X-Rays
$35 / $45
$35 / $45
Complex Diag
$200 / $250
$275 / $550
DME
20% / 25%
20% / 25%
Chemo/Part B
20% / 50%
20% / 50%
Part D
$2 / $8 / $42 / $95
$2 / $8 / 24% / 37%
90 Day- Mailorder
$0 / $0 / $105 / $237
$0 / $0 / $105 / $237
Part D Ded
$195
$320
| (applies to tiers 2,3,4,5) |
| (applies to tiers 2,3,4,5) |
Skilled Nursing
$0 days 1-20
$203 days 21-45
$0 days 1-20
$214 days 21-45
Hearing Aid
$495-$1,695
$495-$1,695
OTC
Pick your Perks($1,525)
Pick your Perks($1,200)
Gym Membership
SilverSneakers
One Pass
Dental
Pick your Perks($1,525)
Pick your Perks($1,200)
Dental Rider
$45/mo $1,000
$45/mo $1,000
Dental Network
ANY/Delta Dental MA
ANY/Delta Dental MA
Vision
Pick your Perks($1,525)
Pick your Perks($1,200)
Thank you for placing your trust and confidence in FHK to service your ongoing Medicare-related health insurance needs.
Customer Service: 800-378-5234
EyeMed link: EyeDocLocator.com
EyeMed Phone: 833-279-4359
Dental Network link: SayCheese
Dental Network Phone: 888-454-4127
TruHearing: 877-759-8131
Find A Doc: NetworkHealth.com
New Gym Membership Link: YourOnePass.com
Mail Order with Express Scripts: 800-316-3107
For a full listing of the Network Health GO PPO, please click here.