Plan Year 7/1/11 - 6/30/12 Plan Facts Cost
Plan Year 7/1/11 - 6/30/12 Plan Facts Cost
Plan Year 7/1/11 - 6/30/12 Plan Facts Cost
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MammogramColonoscopyCancer screeningsCardiovascular screeningsAllergy tests and treatments70% coveredIn Network100% coveredOut of Network70% covered; deductible does not applyIn Network90% coveredOut of Network70% coveredIn NetworkCheck with <strong>Plan</strong> for detailsOut of NetworkCheck with <strong>Plan</strong> for detailsIn NetworkCheck with <strong>Plan</strong> for detailsOut of NetworkCheck with <strong>Plan</strong> for detailsIn Network80% coveredOut of Network70% coveredFertility servicesIn vitro fertilizationArtificial inseminationFemale tubal ligationMale vasectomyIn Network90% covered; limited to one IVF procedure perlifetime; preauthorization required; diagnosis andtreatment of infertility not coveredOut of Network70% covered; limited to one IVF procedure perlifetime; preauthorization required; diagnosis andtreatment of infertility not coveredIn Network90% covered; limited to one procedure per lifetime;eligibility criteria and limitations apply; check with <strong>Plan</strong>for detailsOut of Network70% covered; limited to one procedure per lifetime;eligibility criteria and limitations apply; check with <strong>Plan</strong>for detailsIn NetworkNot coveredOut of NetworkNot coveredIn Network90% coveredOut of Network70% coveredIn Network90% coveredOut of Network
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