21 Benefits In - Network Out - of - Network • Infertility Services Benefits are based on the setting in which Covered Services are received. Mental Health and Substance Use Disorder Services Mental Health and Substance Use Disorder Services are covered as required by state and federal law. Please see the rest of this Schedule for the cost shares that apply in each setting. Occupational Therapy See “Therapy Services.” Office and Home* Visits *Home visits are not the same as Home Health Care. For Home Health Care benefits please see the "Home Health Care" section. Important Note on Office Visits at an Outpatient Facility: If you have an office visit with your PCP or SCP at an Outpatient Facility (e.g., Hospital or Ambulatory Surgery Center), benefits for Covered Services will be paid under the “Outpatient Facility Services” section later in this Schedule. Please refer to that section for details on the cost shares (e.g., Deductibles, Copayments, Coinsurance) that will apply. • Primary Care Physician / Provider (PCP) - Includes Ob/Gyn In - Person Visits: 10% Coinsurance after Deductible Virtual Visits: 10% Coinsurance after Deductible 30% Coinsurance after Deductible • Additional Telehealth/Telemedicine Services from a Primary Care Provider (PCP) (as required by law) 10% Coinsurance after Deductible 30% Coinsurance after Deductible • Mental Health and Substance Use Disorder Provider (Including Psychotherapy and Habilitative / Rehabilitative Therapy Services) In - Person Visits: 10% Coinsurance after Deductible Virtual Visits: 10% Coinsurance after Deductible 30% Coinsurance after Deductible