Summary of Benefits

This chart shows a summary of healthcare services your family may need. The services are covered by the Plan as long as your USFHP primary care provider (PCP) provides or authorizes them. It is important to understand how to take advantage of your coverage and get the care you need. This will help you avoid unnecessary costs or paperwork.

COVERED SERVICES YOUR COST
Annual Physical  $0
Outpatient Visit  $0
Home Health Care  $0
Emergency Room Visit  $0
Ambulatory Surgery  $0
Inpatient Hospitalization (general)  $0
Skilled Nursing Facility Care  $0
Ambulance Service  $0
Durable Medical Equipment (prostheses, supplies)  $0
Physical Therapy  $0
Occupational Therapy  $0
Rehabilitation Therapy (including cardiac)  $0
Radiation Therapy  $0
Routine PAP Smear  $0
Well-Child Care and Immunizations (up to 6 years of age)  $0
Maternity (hospital and professional services, prenatal/postnatal)  $0
Eye Exam  $0
Outpatient Behavioral Health Visit, Individual  $0
Outpatient Behavioral Health Visit, Group  $0
Inpatient Hospitalization, Behavioral Health  $0
Partial Hospitalization, Behavioral Health  $0
Inpatient Hospitalization, Substance Abuse Treatment  $0
Partial Hospitalization, Substance Abuse Treatment  $0
   
Download the Summary of Benefits 2021  

 

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