Common use of Radiation Therapy/Chemotherapy Services Clause in Contracts

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 20% - After Deductible In a doctor’s office 0% - After Deductible 20% - After Deductible Inpatient 0% - After Deductible 20% - After Deductible Outpatient 0% - After Deductible 20% - After Deductible Skilled or sub-acute care* 0% - After Deductible 20% - After Deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 20% - After Deductible Not Covered In a doctor’s office 0% - After Deductible 20% - After Deductible Not Covered Inpatient 0% - After Deductible 20% - After Deductible Not Covered Outpatient 0% - After Deductible 20% - After Deductible Not Covered Skilled or sub-acute care* 0% - After Deductible 20Not Covered Outpatient/in a doctor’s/therapist’s office* 0% - After DeductibleDeductible Not Covered

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible deductible 20% - After Deductible deductible In a doctorphysician’s office 0% - After Deductible deductible 20% - After Deductible deductible Inpatient 0% - After Deductible deductible 20% - After Deductible deductible Outpatient 0% - After Deductible deductible 20% - After Deductible deductible Skilled or sub-acute care* care 0% - After Deductible deductible 20% - After Deductibledeductible Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible 40% - After deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 20% - After Deductible In a doctor’s office 0% - After Deductible 20% - After Deductible Inpatient 0% - After Deductible 20% - After Deductible Outpatient 0% - After Deductible 20% - After Deductible Skilled or sub-acute care* 0% - After Deductible 20% - After Deductible Outpatient/in a doctor’s/therapist’s office* 20% - After Deductible 20% - After Deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 20% - After Deductible deductible In a doctorphysician’s office 0% - After Deductible 20% - After Deductible deductible Inpatient 0% - After Deductible 20% - After Deductible deductible Outpatient 0% - After Deductible 20% - After Deductible deductible Skilled or sub-acute care* care 0% - After Deductible 20% - After Deductibledeductible Outpatient hospital/in a physician’s/therapist’s office. Limited to 30 speech therapy visits per plan year. 20% 20% - After deductible

Radiation Therapy/Chemotherapy Services. Outpatient 020% - After Deductible 2040% - After Deductible In a doctor’s office 0% - After Deductible 20% - After Deductible Inpatient 040% - After Deductible Inpatient 20% - After Deductible Outpatient 040% - After Deductible Outpatient 20% - After Deductible 40% - After Deductible Skilled or sub-acute care* 020% - After Deductible 40% - After Deductible Outpatient/in a doctor’s/therapist’s office* Limited to thirty (30) visits per member per plan year. 20% - After Deductible 20% - After Deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 20deductible 40% - After Deductible deductible In a doctorphysician’s office 0% - After Deductible 20deductible 40% - After Deductible deductible Inpatient 0% - After Deductible 20deductible 40% - After Deductible deductible Outpatient 0% - After Deductible 20deductible 40% - After Deductible deductible Skilled or sub-acute care* care 0% - After Deductible 20deductible 40% - After Deductibledeductible Outpatient hospital/in a physician’s/therapist’s office. 0% - After deductible 40% - After deductible

Radiation Therapy/Chemotherapy Services. Outpatient 020% - After Deductible 2040% - After Deductible In a doctor’s office 0% - After Deductible 20% - After Deductible Inpatient 040% - After Deductible Inpatient 20% - After Deductible Outpatient 040% - After Deductible Outpatient 20% - After Deductible 40% - After Deductible Skilled or sub-acute care* 020% - After Deductible 40% - After Deductible Outpatient/in a doctor’s/therapist’s office* Limited to thirty (30) visits per member per plan year. 20% - After Deductible 40% - After Deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible deductible 20% - After Deductible deductible In a doctorphysician’s office 0% - After Deductible deductible 20% - After Deductible deductible Inpatient 0% - After Deductible deductible 20% - After Deductible deductible Outpatient 0% - After Deductible deductible 20% - After Deductible deductible Skilled or sub-acute care* care 0% - After Deductible deductible 20% - After Deductibledeductible Outpatient hospital/in a physician’s/therapist’s office. Limited to 30 speech therapy visits per plan year. 20% - After deductible 20% - After deductible

Radiation Therapy/Chemotherapy Services. Outpatient 0% - After Deductible 200% - After Deductible In a doctor’s office 0% - After Deductible 200% - After Deductible Inpatient 0% - After Deductible 200% - After Deductible Outpatient 0% - After Deductible 200% - After Deductible Skilled or sub-acute care* 0% - After Deductible 200% - After Deductible Outpatient/in a doctor’s/therapist’s office* Limited to thirty (30) visits per member per plan year. 0% - After Deductible 0% - After Deductible