Office Visits (other than Preventive Care Services). See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. 10% - After deductible Not Covered Hospital based clinic visits $45 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $15 Not Covered PCP does not practice with PCMH model of care $35 Not Covered Retail clinics $45 Not Covered Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $45 Not Covered Office visits and house calls rendered by a behavioral health specialist. $35 Not Covered Organ Transplants Organ transplant services 10% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 10% - After deductible Not Covered
Appears in 1 contract
Samples: Subscriber Agreement
Office Visits (other than Preventive Care Services). See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies applies to injection only, including administration. 10% - After deductible Not Covered Hospital based clinic visits $45 60 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $15 25 Not Covered PCP does not practice with PCMH model of care $35 45 Not Covered Retail clinics $45 50 Not Covered Specialists Office - office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to behavioral health, allergists, dermatologists and podiatrists. $45 Not Covered Office visits and house calls rendered by a behavioral health specialist. $35 60 Not Covered Organ Transplants Organ transplant services 10% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 10% - After deductible Not Covered
Appears in 1 contract
Samples: Subscriber Agreement
Office Visits (other than Preventive Care Services). See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies applies to injection only, including administration. 100% Not Covered Diabetic office visits Podiatrist services - After deductible first routine visit in a plan year $0 Not Covered Vision care services - first routine eye exam in a plan year that includes a retinal eye exam. $0 Not Covered Hospital based clinic visits $45 30 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $15 Not Covered PCP does not practice with PCMH model of care $35 20 Not Covered Retail clinics $45 20 Not Covered Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $45 30 Not Covered Office visits and house calls rendered by a behavioral health specialist. $35 20 Not Covered Organ Transplants Organ transplant services 100% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 1020% - After deductible Not Covered
Appears in 1 contract
Samples: Subscriber Agreement
Office Visits (other than Preventive Care Services). See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. 10% - After deductible Not Covered Hospital based clinic visits $45 60 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $15 25 Not Covered PCP does not practice with PCMH model of care $35 45 Not Covered Retail clinics $45 50 Not Covered Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $45 60 Not Covered Office visits and house calls rendered by a behavioral health specialist. $35 45 Not Covered Organ Transplants Organ transplant services 10% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 10% - After deductible Not Covered
Appears in 1 contract
Samples: Subscriber Agreement