Long Term
Gen 27 FB7 O/P back and spine
n/c
FAD
Gen 20
Gym Memberships
we do not cover
Adult Routine Physical-FTC
not covered
Screening mammogram Illinois-FTH
Paid at 100%
Gen 25 FHU Doctor OV
ded then 100%
FB8
Gen 27-Saver
genetic testing
must be medically necessary and not investigational or experimental
Diagnostic blood work for a short term FTC
ded/coin based on med necess
PSA testing in TN-FTW
coinsurance
gen 23 FHL Florida E.R. visit
ded/coin
FTM
Gen 5 Short term
buy and bill
provider must follow their contract w/network for all billing
Short Term FTO Lifetime max
$2,000,000
HPV Test in West Virginia-FTW
gen 26 FH3 preventive care
100% if done inn & billed HCR
FTL
Gen 4 short term
14 day waiting period
no longer a waiting period as of 9/1/10 for long term
FTO has a per cause deductible-True or False
False only per term deductible
Well child check up for Ohio-FTW
Gen 26 FH4 Mental Health benefits
SAAI-med necess ded/coin
FND
Gen 20
Golden Rule/UHO Tax ID#
37-602-8756
What is the urgent care coverage for an FTO
$75 copay, additional services subjt to ded/coin
Screening Breast Exam for TX-FTW
N/C