Limit: 12.0 Visit(s) per Year

Exclusions: Massage or massage therapy, even as part of a physical therapy program. Homeopathic medicines or homeopathic supplies.

Limit: 20.0 Visit(s) per Year

Exclusions: Massage or massage therapy, even as part of a physical therapy program. Homeopathic medicines or homeopathic supplies.

Limit: 1.0 Procedure(s) per Episode

Exclusions: Charges for inpatient stays that began before you were covered by this plan.

Charges for a hospital room are covered up to the hospital's semi-private room rate (or private room rate, if the hospital does not offer semi-private rooms). Charges for a private room are covered if the attending physician orders hospitalization in an intensive care unit, coronary care unit, or private room for medically necessary isolation.

Limit: 1.0 Item(s) per Benefit Period

No charge up to $150 maximum then subject to medical deductible and coinsurance. See policy for more information.

Gender affirming care is covered when determined by a provider as medically necessary and follows accepted standards of care. Please check with the insurance carrier for coverage information, including any limitations and exclusions.

Limit: 30.0 Visit(s) per Year

Visit limits do not apply to mental health conditions. See policy for more information.

Hearing assistance coverage complies with state and federal law.

Exclusions: Charges for inpatient stays that began before you were covered by this plan.

Charges for a hospital room are covered up to the hospital?s semi-private room rate (or private room rate, if the hospital does not offer semi-private rooms). Charges for a private room are covered if the attending physician orders hospitalization in an intensive care unit, coronary care unit, or private room for medically necessary isolation.

This health plan complies with all federal laws and regulations related to the Mental Health Parity and Addiction Equity Act of 2008.

This health plan complies with all federal laws and regulations related to the Mental Health Parity and Addiction Equity Act of 2008.

Certain drugs may fall under a higher or lower cost sharing amount than is listed here. Insulin: $35 max out of pocket for 30 day supply prior to deductible. See policy for more information.

Certain drugs may fall under a higher or lower cost sharing amount than is listed here. Insulin: $35 max out of pocket for 30 day supply prior to deductible. See policy for more information.

Exclusions: Missed appointments and get acquainted visits. See policy for more information.

Limit: 30.0 Visit(s) per Year

Visit limits do not apply to mental health conditions. See policy for more information.

Certain drugs may fall under a higher or lower cost sharing amount than is listed here. Insulin: $35 max out of pocket for 30 day supply prior to deductible. See policy for more information.

Certain drugs may fall under a higher or lower cost sharing amount than is listed here. Insulin: $35 max out of pocket for 30 day supply prior to deductible. See policy for more information.

Exclusions: Missed appointments and get acquainted visits. See policy for more information.

Limit: 30.0 Visit(s) per Year

Visit limits do not apply to mental health conditions. See policy for more information.

Limit: 30.0 Visit(s) per Year

Visit limits do not apply to mental health conditions. See policy for more information.

Limit: 1.0 Visit(s) per Benefit Period

Exclusions: Orthoptics, vision therapy, or other services to correct refractive error.

Coverage is provided until at least the end of the month in which the enrollee turns 19 years of age. In network: Covered in Full. Out of network: No charge up to $40 maximum, and the remaining cost is member responsibility.

Limit: 60.0 Days per Year

Exclusions: Confinement for custodial care is not covered. See policy for more information.

Exclusions: Missed appointments and get acquainted visits. See policy for more information.

Certain drugs may fall under a higher or lower cost sharing amount than is listed here. $500 cap per script for Standard Gold Plans. See policy for more information.

This health plan complies with all federal laws and regulations related to the Mental Health Parity and Addiction Equity Act of 2008.

This health plan complies with all federal laws and regulations related to the Mental Health Parity and Addiction Equity Act of 2008.

For services that are performed and billed as a true telemedicine visits, copays will be waived. HSA qualified plans will still be subject to the deductible and coinsurance.

For services that are performed and billed as a true telemedicine visits, copays will be waived. HSA qualified plans will still be subject to the deductible and coinsurance.