Preventive services (such as annual physicals, well-baby visits,
immunizations and mammograms) are covered at 100% by the health
plan; there is no member cost associated with these services.
Services to which a copay applies*–
If a copay applies to the service you are obtaining, then that service is
not subject to the deductible. This includes primary care and
specialist office visits, emergency room visits, and prescription drugs.
For these services, your cost is the associated member copay
*Your provider may charge you a facility fee, clinic charge or similar fee (in addition to any copays) if your office visit or service is provided at a location that qualifies as a hospital department or a satellite building of a hospital.
· Diagnostic/Imaging Services (e.g., x-ray, MRI, nonpreventive lab/pathology).
· Inpatient and outpatient surgery.
· Durable medical equipment.
· Chemotherapy, dialysis and infusion therapy.
· Home health care, skilled nursing facility care and hospice care.