What Are My Benefits? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 28 is the primary intended purpose, this would be considered a Cosmetic procedure. The Surest Plan does not provide Benefits for Cosmetic services or procedures. • The fact that a Participant may suffer psychological consequences or socially avoidant behavior as a result of an illness, injury, or congenital anomaly does not classify surgery (or other procedures done to relieve such consequences or behavior) as Reconstructive procedures. • Reconstructive Surgery may require Prior Authorization and Medical Necessity review. Rehabilitative/Habilitative Services and Other Low Intensity Therapy In-Network Out-of-Network Aural Therapy – Post Cochlear Implant $10 to $85 copayment / visit $220 copayment / visit Cardiac Rehabilitation Therapy $35 copayment / visit $105 copayment / visit Chiropractic Visit $15 copayment / visit $45 copayment / visit Cognitive Therapy $10 to $65 copayment / visit $185 copayment / visit Occupational Therapy $10 to $65 copayment / visit $185 copayment / visit Physical Therapy $5 to $45 copayment / visit $135 copayment / visit Speech Therapy $10 to $65 copayment / visit $185 copayment / visit Pulmonary Rehabilitation Therapy $45 copayment / visit $135 copayment / visit Notes: Rehabilitative and habilitative services must be performed by a Physician or by a licensed therapy Provider. Benefits include services provided in a Physician’s office or on an outpatient basis at a hospital, or alternate facility. Services provided in your home are provided as described under the Home Health Care section. • Refer to the Surest mobile app for additional coverage and copayment information. • The copayments for certain therapies may vary based on Provider and location (e.g., aural, cognitive, occupational, physical, and speech therapy). • Routine diagnostic services, including diagnostic lab, x-ray, and ultrasound are included in the Rehabilitative/Habilitative Services copayment. When the routine diagnostic service is prescribed by a doctor and received on a different date of service and location, the service is $0 copayment. • Returning home from a visit with durable medical equipment, such as a walker, may result in an additional copayment. • Aural Therapy does not have visit. limits.Cardiac Rehabilitation is limited to 36 visits per Participant per Plan Year for in-network and out-of-network Providers combined. • Chiropractic does not have visit limits. − Chiropractic Services are limited to manipulative services including chiropractic care and osteopathic manipulation rendered to diagnose and treat acute neuromuscular-skeletal conditions. • Occupational therapy does not have visit limits. • Cognitive therapy does not have visit limits. − Cognitive rehabilitation therapy following traumatic brain injury or cerebral vascular accident is covered when Medically Necessary. • Physical therapy does not have visit limits. • Pulmonary Rehabilitation does not have visit limits. • Speech therapy does not have visit limits. • Therapies provided in the home will be assigned the home health care visit copayment. See Home Health Services for coverage notes. • Note that Occupational Therapy and Physical Therapy are different types of services and the copayment varies based on how the claim is billed. • Therapies related to the treatment of a mental health condition, such as autism disorder, are provided under Behavioral Health – Mental Health and Substance Use Disorder services section and do not apply to limits in this section. Skilled Nursing Facility Services In-Network Out-of-Network Skilled Nursing Facility $1,200 copayment / stay $3,600 copayment / stay Inpatient Rehabilitation Facility $1,200 copayment / stay $3,600 copayment / stay Notes: The Surest Plan provides Benefits for services provided during an inpatient stay in a Skilled Nursing Facility or inpatient rehabilitation facility.