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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Foot care services are covered when administered by a provider and when associated with systemic conditions that are significant enough to result in severe circulatory insufficiency or areas of desensitization in the lower extremities including, but not limited to any of the following:

  • Diabetes mellitus;
  • Peripheral vascular disease;
  • Peripheral neuropathy.

Evaluation/debridement of mycotic nails, in the absence of a systemic condition, when both of the following conditions are met:

  • Pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate;
  • If ambulatory, pain markedly limits ambulation.

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