23 Benefits Speech Therapy See “Therapy Services.” Surgery Benefits are based on the setting in which Covered Services are received. Temporomandibular and Craniomandibular Joint Treatment Benefits are based on the setting in which Covered Services are received. Therapy Services Benefits are based on the setting in which Covered Services are received. Benefit Maximum(s): • Physical Therapy 60 visits per Benefit Period • Occupational Therapy 60 visits per Benefit Period • Speech Therapy 60 visits per Benefit Period • Manipulation Therapy 24 visits per Benefit Period • Cardiac Rehabilitation 36 visits per Benefit Period • Pulmonary Rehabilitation 20 visits per Benefit Period The limits for physical, occupational, and speech therapy will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit. Note: The limits for physical, occupational, and speech therapy will not apply if you get that care as part of the Hospice benefit. Note: If pulmonary rehabilitation is given as part of Physical Therapy, the Physical Therapy limit will apply instead of the Pulmonary Rehabilitation limit. Note: When you get physical, occupational, speech therapy, cardiac rehabilitation, or pulmonary rehabilitation in the home, the Home Care Visit limit will apply instead of the Therapy Services limits listed above. Transplant Services See “Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services.” Urgent Care Services (Office & Home* Visits) *Home visits are not the same as Home Health Care. For Home Health Care benefits please see the "Home Health Care" section.

2025 Retiree Indemnity Plan Booklet - Page 24 2025 Retiree Indemnity Plan Booklet Page 23 Page 25