Page 68 - APPENDICES for Diane Falten
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PART B DRUGS
These are drugs you usually get at a doctor's o ce or hospital outpatient setting, like the u shot,
chemotherapy, or other shots.
Chemotherapy drugs In-network: 20% coinsurance Limits apply
Out-of-network: 30%
coinsurance
Other Part B drugs In-network: 20% coinsurance Limits apply
Out-of-network: 30%
coinsurance
Extra bene ts
HEARING
Hearing exam In-network: $45 copay Limits apply
Out-of-network: 30%
coinsurance
Fitting/evaluation In-network: $0 copay Limits apply
Out-of-network: $0 copay
Hearing aids - all types In-network: $699-999 copay Limits apply
Out-of-network: $699-999
copay
