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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Implantable bone growth stimulators are covered as an outpatient surgery benefit. Some non-implantable bone growth stimulators are covered as durable medical equipment. For details, contact your medical plan.

Preauthorization by medical plan may be required.


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