|Doctors & Hospitals||Amount You Will Pay|
|PCP Office Visits||$20 per visit|
|Specialist Office Visits||$50 per visit|
|Inpatient Hospital||$375 / 5 days per period|
|Emergency Room Care||$120 per visit|
|Diagnostic and X-Ray||$100 / $140 / $180 per visit|
|Routine Lab Services||$0 per visit|
|Outpatient Hospital Services||$375 per visit|
Enhanced Preventive Care
Includes a free annual wellness visit and a wide variety of vaccinations and preventative screenings (including cardiovascular and cancer) at no charge.
Hearing & Vision
Includes $45 annual hearing exam and two hearing aids per year; $699 / $999. Also includes routine vision coverage of $25 per exam - $150 allowance.
Material ID: Y0039_2019_SCPWebsite_M (CMS Accepted) Last Updated 11/09/2018