23 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: $15 Copayment per visit Virtual Visits: $15 Copayment per visit In-Person Visits: $40 Copayment per visit Virtual Visits: $40 Copayment per visit 50% Coinsurance after Deductible • Additional Telehealth/Telemedici ne Services from a Primary Care Provider (PCP) (as required by law) $15 Copayment per visit $40 Copayment per visit 50% Coinsurance after Deductible • Mental Health and Substance Use Disorder Provider(Including Psychotherapy and Habilitative / Rehabilitative Therapy Services) In-Person Visits: $15 Copayment per visit Virtual Visits: $15 Copayment per visit In-Person Visits: $40 Copayment per visit Virtual Visits: $40 Copayment per visit 50% Coinsurance after Deductible • Specialty Care Physician / Provider (SCP) In-Person Visits: $30 Copayment per visit Virtual Visits: $30 Copayment per visit In-Person Visits: $80 Copayment per visit Virtual Visits: $80 Copayment per visit 50% Coinsurance after Deductible • Additional Telehealth/Telemedici ne Services from a Specialty Care Provider (SCP) (as required by law) $30 Copayment per visit $80 Copayment per visit 50% Coinsurance after Deductible • Retail Health Clinic Visit $15 Copayment per visit $40 Copayment per visit 50% Coinsurance after Deductible • Family Planning, Diabetes Education, and Nutritional Counseling (Medical) $15 Copayment per visit $40 Copayment per visit 50% Coinsurance after Deductible • Nutritional Counseling (Mental Health and $15 Copayment per visit $40 Copayment per visit 50% Coinsurance after Deductible