Page 43 - APPENDICES for Vic Bosiger
P. 43
SKILLED NURSING FACILITY
Skilled nursing facility $0 per day for days 1 through Limits apply
20
$188 per day for days 21
through 100
PREVENTIVE SERVICES
Health care to prevent illness or detect illness at an early stage, when treatment is likely
to work best (like Pap tests, u shots, and screening mammograms).
Learn more about your costs for preventive services
Preventive services $0 copay
AMBULANCE
Ground ambulance $255 copay
THERAPY SERVICES
Occupational therapy visit $30 copay Limits apply
Physical therapy & speech $30 copay Limits apply
& language therapy visit
