20 Benefits • Additional Telehealth/Telemedicine Services from a Primary Care Provider (PCP) (as required by law) 20% Coinsurance after Deductible • Mental Health and Substance Use Disorder Provider 20% Coinsurance after Deductible • Specialty Care Physician / Provider (SCP) (Including SCP Online Visits) 20% Coinsurance after Deductible • Additional Telehealth/Telemedicine Services from a Specialty Care Provider (SCP) (as required by law) 20% Coinsurance after Deductible • Retail Health Clinic Visit 20% Coinsurance after Deductible • Counseling- includes Family Planning and Nutritional Counseling (Other than Eating Disorders) 20% Coinsurance after Deductible • Nutritional Counseling for Eating Disorders 20% Coinsurance after Deductible • Allergy Testing 20% Coinsurance after Deductible • Shots / Injections (other than allergy serum) 20% Coinsurance after Deductible • Diagnostic Lab (other than reference labs) 20% Coinsurance after Deductible • Diagnostic X-ray 20% Coinsurance after Deductible • Other Diagnostic Tests ; including Hearing and EKG) 20% Coinsurance after Deductible • Advanced Diagnostic Imaging (including MRIs, CAT scans) 20% Coinsurance after Deductible • Office Surgery (including anesthesia) 20% Coinsurance after Deductible • Therapy Services: - Chiropractic / Osteopathic / Manipulative Therapy 20% Coinsurance after Deductible - Physical Therapy 20% Coinsurance after Deductible - Speech Therapy 20% Coinsurance after Deductible - Occupational Therapy 20% Coinsurance after Deductible - Dialysis 20% Coinsurance after Deductible - Radiation / Chemotherapy / Respiratory Therapy 20% Coinsurance after Deductible - Cardiac Rehabilitation 20% Coinsurance after Deductible - Pulmonary Therapy 20% Coinsurance after Deductible See “Therapy Services” for details on Benefit Maximums. • Prescription Drugs Administered in the Office (includes allergy serum) 20% Coinsurance after Deductible