Common Medical Event | Services You May Need | In-Network Provider (You will pay the least) | Out-of-Network Provider (You will pay the most) | Limitations, Exceptions and Other Important Information |
|---|---|---|---|---|
If you need help recovering or have other special health needs | Home health care | 20% coinsurance | 40% coinsurance | Certification required. |
Rehabilitation services | 20% coinsurance | 40% coinsurance | Certification required. | |
Habilitation services | 20% coinsurance | 40% coinsurance | Maintenance or exercise therapy is excluded. | |
Skilled nursing care | 20% coinsurance | 40% coinsurance | Certification required. | |
Durable medical equipment | 20% coinsurance | 40% coinsurance | Coverage is limited to allowable charge for basic equipment. Prior approval recommended. | |
Hospice services | 20% coinsurance | 40% coinsurance | Certification required. Benefits available for up to six months. |
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