|Doctors & Hospitals||Amount You Will Pay|
|PCP Office Visits||$20 per visit|
|Specialist Office Visits||$50 per visit|
|Inpatient Hospital||$300 / 6 days per period|
|Emergency Room Care||$90 per visit|
|Diagnostic and X-Ray||$70 / $105 / $140 per visit|
|Routine Lab Services||$0 per visit|
|Outpatient Hospital Services||$300 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.
$20 PCP Visit
Includes $20 Primary Care Provider Office visit copay.
Durable Medical Equipment
The plan pays 80% of the cost of in-network purchases of durable medical equipment like wheelchairs. If you choose a preferred vendor, your cost may be less.
Material ID: Y0039_2019_SCPWebsite_M (CMS Accepted) Last Updated 11/21/2018