Page 236 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat
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What You Will Pay
Common Medical Services You May Need Limitations, Exceptions, & Other
Event Network Provider (You Out-of-Network Provider Important Information
will pay the least) (You will pay the most)
If you need help Home health care 10% coinsurance 20% coinsurance Combined network and out-of-network:
recovering or have 100 visits per benefit period, combined
other special health with visiting nurse.
needs Precertification may be required.
Rehabilitation services 10% coinsurance 20% coinsurance Precertification may be required.
Habilitation services Not covered Not covered −−−−−−−−−−−none−−−−−−−−−−−
Skilled nursing care 10% coinsurance 20% coinsurance Combined network and out-of-network:
100 days per benefit period.
Precertification may be required.
Out-of-network: Failure to precertify will
result in benefits payable being
reduced by $250.
Durable medical equipment 10% coinsurance 20% coinsurance Precertification may be required.
Hospice services No charge No charge Precertification may be required.
Deductible does not apply. Deductible does not apply.
If your child needs Children’s eye exam Not covered Not covered −−−−−−−−−−−none−−−−−−−−−−−
dental or eye care Children’s glasses Not covered Not covered −−−−−−−−−−−none−−−−−−−−−−−
Children’s dental check-up Not covered Not covered −−−−−−−−−−−none−−−−−−−−−−−
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