What Are My Benefits? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 17 The Surest Plan provides Benefits for behavioral services for Autism Spectrum Disorder, including Intensive Behavioral Therapies (IBT) such as Applied Behavior Analysis (ABA) that are the following: − Focused on the treatment of core deficits of Autism Spectrum Disorder. − Focused on treating maladaptive/stereotypic behaviors that are posing danger to self, others, property, or impairment in daily functioning. − Provided by a Board-Certified Applied Behavior Analyst (BCBA) or other qualified Provider under the appropriate supervision. • Intensive Behavioral Therapy (IBT) is outpatient behavioral care services that aim to reinforce adaptive behaviors, reduce maladaptive behaviors, and improve the mastery of functional age-appropriate skills in Participants with Autism Spectrum Disorder. • These Benefits describe only the behavioral component of treatment for Autism Spectrum Disorder. Medical treatment of Autism Spectrum Disorder is a Covered Health Service for which Benefits are available under the applicable medical Covered Health Services categories as described in this section. • Visit limits do not apply to therapies provided for a mental health condition, such as autism disorders. • Applied Behavioral Analysis for Autism Spectrum Disorder services may require Prior Authorization and Medical Necessity review. Colonoscopy - Non-Screening In-Network Out-of-Network Colonoscopy – Non-Screening $0 to $800 copayment / visit $2,400 copayment / visit Notes: • Refer to the Surest mobile app for additional coverage information. • Copayments may vary based on Provider and location. • Benefits include Physician services and facility charges. • Coverage is available for a non-screening colonoscopy received on an outpatient basis at a hospital, alternate facility, or in a Physician’s office. • A non-screening colonoscopy is a procedure performed to diagnose disease symptoms. • Services for preventive screenings are provided under the Preventive Care Services section. Complex Imaging In-Network Out-of-Network MRI (Magnetic Resonance Imaging) $75 to $525 copayment / visit $1,425 copayment / visit CT (Computed Tomography) $75 to $450 copayment / visit $1,350 copayment / visit Nuclear Imaging $75 to $725 copayment / visit $2,175 copayment / visit PET scan $75 to $950 copayment / visit $2,850 copayment / visit Notes: • Refer to the Surest mobile app for additional coverage information. • Copayments may vary based on Provider and location. • Benefits include Physician services and facility charges. • If imaging occurs on multiple areas of the body, such as the lumbar spine and the cervical spine, on the same date of service, one copayment applies. • If imaging occurs using different types of imaging machines (e.g., MRI and a CT), on the same date of service, more than one copayment applies. • If your Physician suggests a low-dose CT Scan (LDCT) for lung cancer screening, refer to Preventive Care Services, in this section, for coverage notes.