Page 62 - PWH 2018 Plan Documents

Common Services You May Need W
Medical Event In-Network Prov
(You will pay the

Physician/surgeon fees 0% coinsuranc

Outpatient services Office Visit
0% coinsuranc
If you need Other Outpatie
mental health, 0% coinsuranc
behavioral health,
or substance 0% coinsuranc
abuse services

Inpatient services

If you are Office visits 0% coinsuranc
pregnant Childbirth/delivery professional 0% coinsuranc
services
Childbirth/delivery facility 0% coinsuranc
services

If you need help Home health care 0% coinsuranc
recovering or have
other special Rehabilitation services 0% coinsuranc
health needs Habilitation services 0% coinsuranc
Skilled nursing care 0% coinsuranc

Durable medical equipment 0% coinsuranc

* For more information about limitations and exceptions, see plan or policy d