Physician Services – 90%

Benefits are provided for services and supplies provided by a licensed physician covered under this plan. Licensed physicians covered under this plan are defined on pages 113-114.

Each individual is responsible for the first $10 of covered expenses when a preferred or non-preferred physician bills an office visit. This $10 office visit copayment is in addition to the $10 office visit copayment for an office visit billed by a nonpreferred provider, and these office visit copayments do not apply toward the $200 annual deductible or $2,300 coinsurance maximum.

Covered services include:

• Physician visits.
• An eye examination (including refraction) performed in conjunction with a medical condition such as diabetes, glaucoma or cataracts.
• Hearing exams to determine the presence of an illness, injury or other hearing loss. The plan covers exams by a physician or audiologist, if ordered by a physician. Hearing aids are not covered under the Retired Plan.
• 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.