$20 co-pay 40 visits per calendar year for combined PT and OT 8 You pay 30% after deductible 3 when medically necessary 100 combined in- and out-of-network visits per calendar yearĬovered in full when authorized by doctor You pay 10% after deductible when authorized 100 combined in- and out-of-network visits per calendar year $25 co-pay per visit when authorized by doctor up to 100 visits per calendar year You pay 30% after deductible 3 when authorized after $250 per admission co-pay 60-day annual maximumĬovered in full when authorized by doctor up to 100 visits per calendar year You pay 10% after deductible when authorized after $250 per admission co-pay 60-day annual maximum $20 co-pay primary care $55 co-pay specialist covered in full for testing 6įixed price precertification required limits apply 6,7Ĭovered in full when authorized by doctor 60-day annual maximum Infertility Testing and Treatment, Subject to Precertificationįixed price precertification required limits apply 6 Provided only at the Duke Fertility Center 7 for employees with two years of service limits apply 6ĭoes not include COH, IVF, or other types of artificial conception 6 You pay 10% after deductible when medically necessary $600 or $700 per admission co-pay 5, then covered in fullĪfter $600 or $700 per admission co-pay 5 and deductible, you pay 10% co-insuranceħ0% after $900 per admission co-pay and deductible 3 Subject to $600 annual deductible you pay 10% co-insurance $600 per admission co-pay 4, then covered in full You pay 30% after deductible 3 for professional services $20 co-pay first visit, then professional services covered in full $75 co-pay specialist first visit, then professional services covered in full $20 co-pay primary care or $55 co-pay specialist first visit, then professional services covered in full Well visits not covered you pay 30% after deductible 3 for PAP smear, mammogram, and sick visits Duke Options Blue Cross Blue Shield PPO (In-Network)ĭuke Options Blue Cross Blue Shield PPO (Out-of- Network)
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