24 Benefits • Urgent Care Visit Charge 20% Coinsurance after Deductible • Allergy Testing 20% Coinsurance after Deductible • Shots / Injections (other than allergy serum) 20% Coinsurance after Deductible • Allergy Shots / Injections (including allergy serum) 20% Coinsurance after Deductible • Diagnostic Labs (i.e., 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 • Prescription Drugs Administered in the Office (includes allergy serum) 20% Coinsurance after Deductible Note: If you get urgent care at a Hospital or other outpatient Facility, please refer to “Outpatient Facility Services” for details on what you will pay. Virtual Visits (from Virtual Care Only Providers) Virtual Care-Only Providers through our mobile app and website: • Virtual Visits including Primary Care from Virtual Care-Only Providers (Medical Services) From In-Network Virtual Care-Only Providers including KChat: No Copayment, Deductible, or Coinsurance From In-Network Virtual Care-Only Providers including LiveHealth Online: 20% Coinsurance after Deductible • Virtual Visits from Virtual Care-Only Providers (Mental Health and Substance Use Disorder Services) 20% Coinsurance after Deductible • Virtual Visits from Virtual Care-Only Providers (Specialty Care Services) 20% Coinsurance after Deductible If Preventive Care is provided during a Virtual Visit, it will be covered under the “Preventive Care” benefit, as required by law. Please refer to that section for details.