Active employees & non–Medicare-eligible retirees
| Benefit | Plan Pay |
|---|---|
| Medicare-covered Preventive Care and Screening Tests | $15 per visit |
| Office visits (sick care/non-preventive) | $15 per visit |
| Emergency room | $50 per visit |
| Inpatient hospital care | $50 per admission* |
| Immunizations and injections | Nothing |
| Diagnostic testing | Nothing |
| X-rays and lab tests | Nothing |
*Limited to one copayment per member per calendar-quarter.
(If you visit a specialist, you will need a referral from your primary care physician in order to receive full benefits. Otherwise, your coverage will be limited to Medicare benefits only.)
