18 Advanced Diagnostic Imaging (including MRIs, CAT scans) 20% Coinsurance after Deductible As described in the Consolidated Appropriations Act of 2021 Notice at the front of this Booklet, for Emergency Services, Out - of - Network Providers may only bill you for any applicable Copayments, Deductible and Coinsurance and may not bill you for any charges over the Plans Maximum Allowed Amount until the treating Out - of - Network Provider has determined you are stable and followed the notice and consent process . Please refer to the Notice at the beginning of this Booklet for more details. Habilitative Services Benefits are based on the setting in which Covered Services are received. See Therapy Services for details on Benefit Maximums. Home Health Care Home Health Care Visits from a Home Health Care Agency (Including intermittent skilled nursing services) 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Home Dialysis 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Home Infusion Therapy / Chemotherapy 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Specialty Prescription Drugs for Infusion / Injection Other than Chemotherapy 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Other Home Health Care Services / Supplies 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Private Duty Nursing (Including continuous complex skilled nursing services) 20% Coinsurance after Deductible 40% Coinsurance after Deductible 50% Coinsurance after Deductible Home Health Care Benefit Maximum 120 visits per Benefit Period , In - and Out - of - Network combined The limit includes Private Duty Nursing and Therapy Services (e.g., physical, speech, occupational, cardiac and pulmonary rehabilitation) given as part of the Home Care benefit. The limit does not apply to Home Infusion Therapy or Home Dialysis.