Page 68 - APPENDICES for Stephen Spero
P. 68

OPIOID TREATMENT PROGRAM SERVICES


      Opioid treatment program services


      Limits apply






      OTHER SERVICES


      Durable medical equipment (like wheelchairs & oxygen)

      $0 copay or 20% coinsurance per item

      Limits apply



      Prosthetics (like braces, arti cial limbs)
      20% coinsurance per item

      Limits apply



      Diabetes supplies

      $0 copay

      Limits apply







   Extra bene ts & costs




      HEARING



      Hearing exam
      20% coinsurance

      Limits apply




      Fitting/evaluation
      $0 copay

      Limits apply



      Hearing aids - All types
      $0 copay

      Limits apply
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