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Plan Summary
Plan Name : S1
Plan Type : CDHC

Selected Provider Networks
Name Tier
None
 
Outpatient Services
    Service Payment Source Payment Rule
  Annual Physical Exam
  Chiropractic Services
    Maximum Dollar Limit
  Medical Office Visit with Referral
  Medical Office Visit without Referral
  Psychiatric Services
Inpatient Services
    Service Payment Source Payment Rule
  Inpatient Hospitalization
  Inpatient Surgery
Care Management Services
    Service Payment Source Payment Rule
  Diabetes Glucose Monitor
  Diabetes Office Visit
 

 

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questions and answers
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