Page 33 - APPENDICES for Vic Bosiger
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HEARING
Hearing exam In-network: $0 copay Limits apply
Fitting/evaluation Not covered
Hearing aids - all types In-network: $375-1,425 copay Limits apply
PREVENTIVE DENTAL
Care to prevent or nd problems with your teeth and gums.
Oral exam In-network: $0 copay Limits apply
Out-of-network: $0 copay
Cleaning In-network: $0 copay Limits apply
Out-of-network: $0 copay
Fluoride treatment In-network: $0 copay Limits apply
Out-of-network: $0 copay
Dental x-rays In-network: $0 copay Limits apply
Out-of-network: $0 copay
