Flex Deductible Series maintains a copay schedule for network office visits and outpatient care. These copays apply to all Flex Deductible Series options.
| Office/Outpatient Care | |
|---|---|
| Doctor's Office Visits | |
| Primary and OB/GYN Care | $20 |
| Specialist | $40 |
| Physical/Occupational Therapy | |
| (30 visits per cal. year*) | $40 |
| Spinal Manipulations and Speech Therapy | |
| (20 visits each per cal. year*) | $40 |
| Cardiac and Pulmonary Rehabilitation | |
| (36 sessions each per cal. year*) | $40 |
| X-Ray/Radiology/Diagnostics1 | |
| Routine Radiology | $40 |
| MRI/MRA, CT Scans, PET Scans** | $80 |
| Injectable Medications | |
| Standard Injectables | $0 |
| Biotech/Specialty Injectables** | $100 |
| Lab/Pathology1 | |
| Copayment: | $0 |
* For Personal Choice, combined in/out-of-network maximum.
** Pre-authorization required.
1For Personal Choice options, deductibles and coinsurance apply to these services. For this benefit, copayment amounts only apply to HMO and Keystone Direct POS options.