Physician Services – 90%

Benefits are provided for covered services and supplies provided by a licensed physician covered under this plan. Licensed physicians covered under this plan are listed in Glossary of Terms.

Each individual is responsible for the first $10 of covered expenses when a physician or mental health care provider bills an office visit. Each individual is also responsible for an additional $10 of covered expenses when a nonpreferred provider bills an office visit (for care received in Washington State only). This $10 or $20 office visit copayment does not apply toward the $200 annual deductible or $2,300 annual coinsurance maximum.

Covered services include:

• Physician visits.
• An eye examination (including refraction) performed in conjunction with a medical condition such as diabetes, glaucoma and cataracts.
• Hearing exams to determine the presence of an illness, injury or other hearing loss. The plan covers exams by a physician or audiologist.
• Injectable legend drugs administered in a physician’s office that are used to treat a covered condition. Routine immunizations are not covered, except as provided for under Preventive Care.
• Chemotherapy, radium therapy and other radioactive-type therapies.
• Allergy testing up to an annual maximum of $600.
• Antigen and allergy vaccines or serums.

The services of a chiropractor (DC) are not paid under this benefit. Chiropractors are paid under Chiropractic Care.