Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments up to a combined total of 12 visits per member per plan year. $45 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible The level of coverage is the same as network provider.
Appears in 4 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments without electrical stimulation up to a combined total of 12 visits per member per plan year. $45 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible The level of coverage is the same as network provider.
Appears in 4 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments without electrical stimulation up to a combined total of 12 visits per member per plan year. $45 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible $50 The level of coverage is the same as network provider.
Appears in 1 contract
Samples: Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments without electrical stimulation up to a combined total of 12 visits per member per plan year. $45 30 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible 50 The level of coverage is the same as network provider.
Appears in 1 contract
Samples: Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments without electrical stimulation up to a combined total of 12 visits per member per plan year. $45 30 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible $50 The level of coverage is the same as network provider.
Appears in 1 contract
Samples: Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments without electrical stimulation up to a combined total of 12 visits per member per plan year. $45 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible The level of coverage is the same as network provider.
Appears in 1 contract
Samples: Subscriber Agreement
Acupuncture Services. In a provider's office - One initial evaluation per provider per plan year and acupuncture treatments up to a combined total of 12 visits per member per plan year. $45 The level of coverage is the same as network provider. Ambulance Services Ground $50 The level of coverage is the same as network provider. Air/water* - Up to the benefit limit of $3,000 per occurrence. 10% - After deductible $50 The level of coverage is the same as network provider.
Appears in 1 contract
Samples: Subscriber Agreement