Benefits and coverage table
Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information
Network Provider (You will pay the least) Non-Network Provider (You will pay the most)
If you are pregnant Office visits No charge 50% coinsurance Cost sharing does not apply to certain preventive services. Depending on the type of services, copay, coinsurance or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services No charge after deductible 50% coinsurance None
Childbirth/delivery facility services No charge after deductible 50% coinsurance None
If you need help recovering or have other special health needs Home health care No charge after deductible 50% coinsurance (100 visits per benefit period)
Rehabilitation services (Physical Therapy) No charge after deductible 50% coinsurance (20 visits per benefit period)
Habilitation services (Occupational Therapy) No charge after deductible 50% coinsurance (20 visits per benefit period)
Habilitation services (Speech Therapy) No charge after deductible 50% coinsurance (20 visits per benefit period)
Skilled nursing care No charge after deductible 50% coinsurance (90 days per benefit period)
Durable medical equipment No charge after deductible 50% coinsurance None
Hospice services No charge after deductible 50% coinsurance None
If your child needs dental or eye care Children's eye exam No charge 50% coinsurance None
Children's glasses Not Covered Excluded Service
Children's dental check-up Not Covered Excluded Service