Alcohol, Drug or Other Substance Abuse Detoxification |
$5 co-payment |
Ambulance |
No charge |
Durable Medical Equipment |
No charge |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness of adults and the treatment of Serious Emotional Disturbance |
$5 co-payment |
Oral Surgery Services
No dental |
No charge |
Outpatient Medical Rehabilitation Therapy at a Participating Free-Standing or Outpatient Surgery Facility |
No charge |
Outpatient Surgery at a Participating Free-Standing or Outpatient Surgery Facility |
No charge |
Periodic Health Evaluations
Physician, laboratory, radiology and related services as recommended by the American Academy of Pediatrics, Advisory Committee on Immunization Practices and U.S. Preventive Services Task Force and authorized through the patient's primary care physician |
No charge |
Physician Office Visit |
$5 co-payment |
Well-Woman Care Office Visit
Includes PAP smear by PCP or an OB/GYN in Primary Medical Group and a referral by the Primary Medical Group for screening mammography as recommended by the U.S. Preventive Services Task Force |
No charge |