19 Benefits In-Network Out-of-Network 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 (Including In-Person and/or Virtual Visits) In-Person Visits: 20% Coinsurance after Deductible Virtual Visits: 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Additional Telehealth/Telemedicine Services from a Primary Care Provider (PCP) (as required by law) 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Mental Health and Substance Use Disorder Provider (Including In-Person and/or Virtual Visits) In-Person Visits: 20% Coinsurance after Deductible Virtual Visits: 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Specialty Care Physician / Provider (SCP) (including In- Person and/or Virtual Visits) In-Person Visits: 20% Coinsurance after Deductible Virtual Visits: 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Additional Telehealth/Telemedicine Services from a Specialty Care Provider (SCP) (as required by law) 20% Coinsurance after Deductible 40% Coinsurance after Deductible