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. $0 20% - After deductible Hospital based clinic visits $30 20% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. $20 20% - After deductible Retail clinics $20 20% - After deductible 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. $30 20% - After deductible Office visits and house calls rendered by a behavioral health specialist. $20 20% - After deductible Podiatrist Services - one foot evaluation in a plan year when performed to treat members with a systemic condition such as metabolic, neurologic, or peripheral vascular disease. $0 20% - After deductible Organ Transplants Organ transplant services 0% - After deductible 20% - After deductible Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible 40% After deductible
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. $0 0% 20% - After deductible Hospital based clinic visits $30 50 20% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. $20 30 20% - After deductible Retail clinics $20 30 20% - After deductible 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. $30 50 20% - After deductible Office visits and house calls rendered by a behavioral health specialist. $20 30 20% - After deductible Podiatrist Services - one foot evaluation in a plan year when performed to treat members with a systemic condition such as metabolic, neurologic, or peripheral vascular disease. $0 0% 20% - After deductible Organ Transplants Organ transplant services 0% - After deductible 20% - After deductible Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible 40% After deductible
Appears in 1 contract
Samples: Subscriber Agreement