24 Benefits In-Network Out-of-Network Therapy Services Benefits are based on the setting in which Covered Services are received. Benefit Maximum(s): Benefit Maximum(s) are for In- and Out-of- Network visits combined, and for office and outpatient visits combined. • Physical Therapy 20 visits per Benefit Period • Occupational Therapy 20 visits per Benefit Period • Speech Therapy 20 visits per Benefit Period • Manipulation Therapy 20 visits per Benefit Period • Cardiac Rehabilitation Unlimited • Pulmonary Rehabilitation Unlimited • Acupuncture 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, or cardiac rehabilitation, or pulmonary rehabilitation in the home, the Home Health 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. • Urgent Care Visit Charge 20% Coinsurance after Deductible 50% Coinsurance after Deductible • Allergy Testing 20% Coinsurance after Deductible 50% Coinsurance after Deductible • Shots / Injections (other than allergy serum) 20% Coinsurance after Deductible 50% Coinsurance after Deductible