• Inpatient Facility No Copayment, No Copayment, 50% Coinsurance Services Deductible, or Deductible, or after Deductible. Coinsurance Coinsurance These charges will NOT apply to your Out-of-Pocket Limit. • Outpatient Facility No Copayment, No Copayment, 50% Coinsurance Services Deductible, or Deductible, or after Deductible. Coinsurance Coinsurance These charges will NOT apply to your Out-of-Pocket Limit. • Donor Health For Human Organ and Tissue Transplants, Medically Necessary charges for Service Limit getting an organ from a live donor are covered up to our Maximum Allowed Amount, including complications from the donor procedure for up to six weeks from the date of procurement. 32
Plan 2 SPD 2025 Page 32 Page 34