Other practitioner visits: Retail health clinic $30 copay per visit 30% coinsurance after deductible is met On-line Medical Visit $20 copay per visit 30% coinsurance Live Health Online is the preferred telehealth solutions () after deductible is met Chiropractic services $30 copay per visit 30% coinsurance Coverage for In-Network Provider and Non-Network Provider combined is after deductible is limited to 30 visits for Rehabilitation and Habilitative per benefit period. met Other services in an office: Allergy testing $30 copay per visit 30% coinsurance after deductible is met Chemo/radiation therapy 20% coinsurance 30% coinsurance after deductible is after deductible is met met Dialysis/Hemodialysis 20% coinsurance 30% coinsurance after deductible is after deductible is met met Prescription drugs 20% coinsurance 30% coinsurance For the drugs itself dispensed in the office thru infusion/injection] after deductible is after deductible is met met Diagnostic Services Lab: Office 20% coinsurance 30% coinsurance after deductible is after deductible is met met Preferred Reference Lab Covered in Full 30% coinsurance after deductible is met Outpatient Hospital 20% coinsurance 30% coinsurance after deductible is after deductible is met met
Other practitioner visits: Retail health clinic $30 copay per visit 30% coinsurance after deductible is met On-line Medical Visit Live Health Online is the preferred telehealth solutions () $20 copay per visit 30% coinsurance after deductible is met Chiropractic services Coverage for In-Network Provider and Non-Network Provider combined is limited to 30 visits for Rehabilitation and Habilitative per benefit period. $30 copay per visit 30% coinsurance after deductible is met Other services in an office: Allergy testing $30 copay per visit 30% coinsurance after deductible is met Chemo/radiation therapy 20% coinsurance after deductible is met 30% coinsurance after deductible is met Dialysis/Hemodialysis 20% coinsurance after deductible is met 30% coinsurance after deductible is met Prescription drugs For the drugs itself dispensed in the office thru infusion/injection] 20% coinsurance after deductible is met 30% coinsurance after deductible is met Diagnostic Services Lab: Office 20% coinsurance after deductible is met 30% coinsurance after deductible is met Preferred Reference Lab Covered in Full 30% coinsurance after deductible is met Outpatient Hospital 20% coinsurance after deductible is met 30% coinsurance after deductible is met
Franklin-City-Public-Schools-2018-SPD-Anthem-HealthKeepers-POS-OA-30-1000-20-4500.docx