Outpatient Mental Health and Substance Use Disorder Doctor Office Visit and Online Visit 20% coinsurance 30% coinsurance after deductible is after deductible is met met Facility visit: Facility fees 20% coinsurance 30% coinsurance after deductible is after deductible is met met Doctor Services 20% coinsurance 30% coinsurance after deductible is after deductible is met met Outpatient Surgery Facility fees: Hospital 20% coinsurance 30% coinsurance after deductible is after deductible is met met Freestanding Surgical Center 20% coinsurance 30% coinsurance after deductible is after deductible is met met Doctor and other services 20% coinsurance 30% coinsurance Surgery after deductible is after deductible is met met Hospital Stay (all inpatient stays including maternity, mental and substance use disorder) Facility fees (for example, room & board) 20% coinsurance 30% coinsurance after deductible is after deductible is met met Doctor and other services 20% coinsurance 30% coinsurance after deductible is after deductible is met met
Outpatient Mental Health and Substance Use Disorder Doctor Office Visit and Online Visit 20% coinsurance after deductible is met 30% coinsurance after deductible is met Facility visit: Facility fees 20% coinsurance after deductible is met 30% coinsurance after deductible is met Doctor Services 20% coinsurance after deductible is met 30% coinsurance after deductible is met Outpatient Surgery Facility fees: Hospital 20% coinsurance after deductible is met 30% coinsurance after deductible is met Freestanding Surgical Center 20% coinsurance after deductible is met 30% coinsurance after deductible is met Doctor and other services Surgery 20% coinsurance after deductible is met 30% coinsurance after deductible is met Hospital Stay (all inpatient stays including maternity, mental and substance use disorder) Facility fees (for example, room & board) 20% coinsurance after deductible is met 30% coinsurance after deductible is met Doctor and other services 20% coinsurance after deductible is met 30% coinsurance after deductible is met
Franklin-City-Public-Schools-2018-SPD-Anthem-HealthKeepers-HSA-3000-20-5000.docx