2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 84 Services that are covered for you What you must pay when you get these services in-network and out-of-network There is no coinsurance, Depression screening copayment, or deductible for an We cover one screening for depression per year. The annual depression screening screening must be done in a primary care setting that can visit. provide follow-up treatment and/or referrals. There is no coinsurance, Diabetes screening copayment, or deductible for We cover this screening (includes fasting glucose tests) if the Medicare-covered diabetes you have any of the following risk factors: high blood screening tests. pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests may also be covered if you meet other requirements, like being overweight and having a family history of diabetes. Based on the results of these tests, you may be eligible for up to two diabetes screenings every plan year. Diabetes self-management training, diabetic services and supplies For all people who have diabetes (insulin and non-insulin users). Covered services include: · Supplies to monitor your blood glucose: blood glucose $0 copayment for each monitor, blood glucose test strips, lancet devices and Medicare-covered diabetes †† lancets, and glucose-control solutions for checking the monitoring supply. accuracy of test strips and monitors. UnitedHealthcare® Group Medicare Advantage PEBB We only cover Accu-Chek® and Complete (PPO) covers any blood glucose monitors and test OneTouch® brands. strips specified within this list. We will generally not cover alternate brands unless your doctor or other provider tells us Covered glucose monitors that use of an alternate brand is medically necessary in your include: OneTouch Verio Flex®, specific situation. If you are new to UnitedHealthcare® OneTouch Verio Reflect®, Group Medicare Advantage PEBB Complete (PPO) and are OneTouch® Verio,