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HSA Plan

Network

20% coinsurance after deductible

Non-Network

Network Benefit

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

Network Benefit

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

Network Benefit

The following ambulance transport services are covered:

  • By ground to the nearest appropriate facility when other means of transportation would not be appropriate.
  • By air to the nearest appropriate facility when the member's medical condition is such that transportation by either basic or advanced life support ground ambulance is not appropriate.

Preauthorization required for non-emergent air or ground ambulance services.


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