Page 26 - QCS.19 Employee Benefits

Common Services You May Need Network Provi
Medical Event services (You will pay the

Home health care 0% coinsurance

Rehabilitation services 0% coinsurance
Habilitation services 0% coinsurance

If you need help Skilled nursing care 0% coinsurance
recovering or have
other special health
needs

Durable medical equipment 0% coinsurance

Hospice services 0% coinsurance

If your child needs Children’s eye exam Not covered
dental or eye care Children’s glasses Not covered
Children’s dental check-up Not covered

* For more information about limitations and exceptions, see the plan or policydocu