X-ray: Office 20% coinsurance 30% coinsurance after deductible is after deductible is met met Freestanding Radiology Center 20% coinsurance 30% coinsurance after deductible is after deductible is met met Outpatient Hospital 20% coinsurance 30% coinsurance after deductible is after deductible is met met Advanced diagnostic imaging (for example, MRI/PET/CAT scans): Office 20% coinsurance 30% coinsurance after deductible is after deductible is met met Freestanding Radiology Center 20% coinsurance 30% coinsurance after deductible is after deductible is met met Outpatient Hospital 20% coinsurance 30% coinsurance after deductible is after deductible is met met Emergency and Urgent Care Emergency room facility services 20% coinsurance Covered as after deductible is met Emergency room doctor and other services 20% coinsurance Covered as after deductible is met Ambulance Transportation 20% coinsurance Covered as after deductible is met Urgent Care Center Office Visit 20% coinsurance 30% coinsurance after deductible is after deductible is met met
X-ray: Office 20% coinsurance after deductible is met 30% coinsurance after deductible is met Freestanding Radiology Center 20% coinsurance after deductible is met 30% coinsurance after deductible is met Outpatient Hospital 20% coinsurance after deductible is met 30% coinsurance after deductible is met Advanced diagnostic imaging (for example, MRI/PET/CAT scans): Office 20% coinsurance after deductible is met 30% coinsurance after deductible is met Freestanding Radiology Center 20% coinsurance after deductible is met 30% coinsurance after deductible is met Outpatient Hospital 20% coinsurance after deductible is met 30% coinsurance after deductible is met Emergency and Urgent Care Emergency room facility services 20% coinsurance after deductible is met Covered as Emergency room doctor and other services 20% coinsurance after deductible is met Covered as Ambulance Transportation 20% coinsurance after deductible is met Covered as Urgent Care Center Office Visit 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