Page 6 - 2020 McLennan County Benefits Enrollment Guide
P. 6
Effective January 1, 2020 Plan 1 Plan 2
Base Plan Consumer Driven Health Plan
Durable Medical Equipment
Durable Medical Equipment (includes blood glucose
meters, continuous glucose monitoring systems, as 50% After Deductible $0 after deductible
applicable)
Diabetic Self-Management Training
Education/Nutrition Counseling (for SWHP ONLINE Self-
Management tools –no charge; deductible does not apply) $35 Copay $0 Copay after deductible
Outpatient - Behavioral Health/Chemical Abuse Services
Behavioral Health $35 Copay $0 Copay after deductible
Alcohol and Drug Dependency $35 Copay $0 Copay after deductible
Inpatient - Behavioral Health/Chemical Abuse Services
Mental Illness, Serious Mental Illness, Treatment of
Chemical Dependency 20% After Deductible 0% after deductible
Alcohol and Drug Dependency 20% After Deductible 0% after deductible
Home Infusion Therapy
Home Infusion Therapy (requires pre-authorization) 20% After Deductible 0% after deductible
Home Health Services
Home Health (requires pre-authorization) $35 Copay $0 Copay after deductible
Hospice (requires pre-authorization) No Charge 0% after deductible
Emergency Care Services
Emergency Room: in-network / out-of-network-
subject to balance billing $250 Copay + 20% After Deductible 0% after deductible
Urgent Care: in-network / out-of-network-subject to
balance billing $75 Copay 0% after deductible
Ambulance 20% After Deductible 0% after deductible
Prescription Drug (Rx) Coverage On Next Page
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