26 Rehabilitation Services Benefits are based on the setting in which Covered Services are received. See “Inpatient Services” and “Therapy Services” for details on Benefit Maximums. Respiratory Therapy See “Therapy Services.” Skilled Nursing Facility See “Inpatient Services.” Speech Therapy See “Therapy Services.” Surgery Benefits are based on the setting in which Covered Services are received. Temporomandibular and Craniomandibular Joint Treatment Benefits are based on the setting in which Covered Services are received. 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 and Occupational Therapy 40 visits per Benefit Period • Speech Therapy 20 visits per Benefit Period • Manipulation Therapy 12 visits per Benefit Period • Cardiac Rehabilitation 36 visits per Benefit Period • Pulmonary Rehabilitation 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 (based on the primary diagnosis on the claim form). Note: The limits for physical, occupational, and speech therapy will not apply if you get that care as part of the Hospice benefit.
Benefit Booklet: Plan 1 Page 26 Page 28