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Copayment obligation is limited to the first 30 hours or $1,500 whichever occurs first, during one calendar year (copayment limits are calculated separately for each discipline.) Physician Visits Full coverage, including laboratory and radiology.
Copayment $.50 to $3 copayment per service (varies by service provided).
Limited to $30 per provider per calendar year.
No copayment for emergency services, anesthesia, or clozapine management. Podiatric Services Full coverage.
Copayment $.50 to $3 per service. Prenatal/Maternity Care Full coverage, including prenatal care coordination and preventive mental health and substance abuse screening and counseling for pregnant women at risk of mental health or substance abuse problems.
No copayment. Reproductive Health Services Full coverage, excluding infertility treatments, surrogate parenting, and related services, including but not limited to artificial insemination, and subsequent obstetrical care as a non-covered service, and the reversal of voluntary sterilization.
No copayment for family planning services. Routine Vision Full coverage including coverage of eye glasses.