Advanced imaging includes CAT Scan, MRI, and PET scans. Advanced imaging is subject to the annual deductible and coinsurance; including the costs associated with the image itself as well as cost associated with the radiologist's reading of the image.

Advanced imaging performed in a PCP, Specialist and/or Inpatient hospital/Outpatient facility settings is subject to the annual deductible and coinsurance.

Local emergency ambulance service or air ambulance to the nearest hospital if medically necessary and confirmed by a licensed provider. Non-emergency transportation is covered if it is provided by a licensed professional ambulance (either ground or air ambulance as determined appropriate) when the transport is from an out-of-network hospital to an in-network hospital; to a hospital that provides a higher level of care that was not available at the original hospital; to a more cost-effective acute care facility; or from an acute facility to a sub-acute setting.

Please note that Cigna administers the ambulance benefit on a per day basis, not per ride.

Lab work includes tests such as complete blood count (CBC), basal metabolism, lipid panel, liver panel, hemoglobin A1C, etc. Generally, you will be assessed a single copay per blood draw even if multiple tests are performed on that single blood draw.

Labs also includes the following: hearing test, heart monitor, pre-admission testing and genetic testing (when approved as medically necessary).

Chiropractic care when medically necessary as determined by Aetna/Cigna to diagnose or treat illness, injury, or disease. Coverage is limited to 20 visits per year (including initial consultation) and ends once maximum medical recovery has been achieved and treatment is primarily for maintenance and/or managing pain.

Durable medical equipment (DME) and supplies ordered or provided by a Physician. DME equipment/supplies or other items that are subject to the annual deductible and coinsurance include: crutches; wheelchair; walker; cane; insulin pump; surgical dressings; casts; splints; trusses; orthopedic braces; hearing aids⁶; custom-molded shoe inserts prescribed to treat a condition, disease or illness affecting the function of the foot; hospital bed; ventilator; iron lung; artificial limbs (excluding replacements); artificial eyes and larynx (including fitting); heart pacemaker; ostomy supplies, including pouches, face plates and belts, irrigation sleeves, bags and ostomy irrigation catheters, and skin barriers and bags; manual pump-operated enema systems and other items necessary to the treatment of an illness or injury that are not excluded under the plans.

For more details on covered DME, please contact Aetna or Cigna. Prior authorization or pre-certification may be required for coverage of some medical equipment and supplies. Aetna and Cigna may authorize purchase of an item if more cost-effective than rental.

If you go to the emergency room and are subsequently admitted to the hospital, the ER copay will be waived and the inpatient hospital admission will be subject to the annual deductible and coinsurance.

If you're provided with a durable medical equipment upon discharge (e.g., crutches or wheelchair), that will be subject to the annual deductible and coinsurance.

This category includes procedures or surgeries performed in an outpatient facility, without an overnight stay, such as at an ambulatory surgical center.

The types of procedures performed at an outpatient facility include endoscopies (includes colonoscopies), cardiac catheterization, upper gastrointestinal, diagnostic colonoscopy, ovary removal, hernia repair, tonsil removal, cataract, kidney stone removal, etc. Please note: this is not meant to be an exhaustive list of services performed outpatient.

Outpatient Procedure/Surgery fees related to professional services (e.g., doctor or surgeon costs) and the facility charges (e.g., cost of the center itself) are subject to the annual deductible and coinsurance

Lab work, standard radiology (e.g., X-rays) and advanced imaging (e.g., CAT scans) performed at an outpatient facility will be assessed a separate cost share. Dialysis or an infusion performed during an outpatient facility visit⁵ is subject to the annual deductible and coinsurance; this is inclusive of the costs of the associated infused drugs.

Outpatient mental health/substance use therapy includes office visits with: Psychologists, Psychiatrists, Clinical Social Workers, Drug and Alcohol Counselors, Licensed Professional Counselors, Marriage/Family Therapists, Behavioral Health Nurse Practitioners, and Psychiatric Nurses.

Lab work, standard radiology (e.g., X-rays) and advanced imaging (e.g., CAT scans) performed during a mental health, chemical, alcohol dependence outpatient therapy visit will be assessed a separate cost share.

Physical, speech, occupational, and cognitive rehabilitation therapy rendered by a licensed therapist, up to a combined total of 60 in- and out-of-network visits per calendar year per therapy type, when the underlying condition/diagnosis is medical in nature. For instance, the plan provides 60 PT visits in total (in- and out-of-network visits combined), 60 ST visits in total (in- and out-of-network visits combined), etc.

For those individuals with a mental health diagnosis¹, associated medical treatments for physical, occupational, speech therapy and cognitive rehabilitation therapy will not be subject to an annual visit limitation. Further, the cost share for these services will be subject to 20% coinsurance (no deductible) rather than the copayment amounts noted in "In-Network Medical Costs, Deductibles, and Out-of-Pocket Maximums" starting.

Preventive care services are covered at 100% in-network by the Medical Plan and include routine care such as:

Detailed preventive care flyers from Aetna and Cigna, which will include the types of preventive care and any associated frequency, are available on aetna.com and mycigna.com.

Preventive care services are determined by your healthcare company based on guidelines and clinical recommendations developed for the general population by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and other nationally recognized sources. JPMorganChase does not make this determination. Age and frequency limits may apply.

Primary care office visits are non-preventive care visits with the following types of clinicians: Primary Care physician (PCP), OB/GYNs, GYNs, Pediatricians, Family Practitioners, General Practitioners, Internal Medicine (contracted as PCPs with Aetna/Cigna), Certified Nurse Midwife, Nurse Practitioner, and Physician Assistants (within a PCP's office).

Convenience care clinics (e.g., CVS Minute Clinic) are treated as a primary care office visit.

"Incidental" labs, such as a swab for strep throat, urine analysis for a urinary tract infection (UTI), etc., are included in the PCP copay (not a separate copay when performed as part of the office visit). Other lab work (e.g., blood draw), and all standard radiology (e.g., X-rays) and advanced imaging (e.g., CAT scans) performed during a PCP visit will be assessed a separate cost share based on the type of service

Office visit with a specialist, such as: ABA/BCBA therapist, acupuncturist, allergist³, cardiologist, dermatologist, endocrinologist, oncologist, otorhinolaryngologist/otolaryngologist (ENT specialist), rheumatologist, reproductive endocrinologist, etc. Please note: this is not intended to be an exhaustive list of all specialists.

Please note: ABA therapy will be subject to 20% coinsurance (no deductible)¹, rather than the copayment amounts noted in "In-Network Medical Costs, Deductibles, and Out-of-Pocket Maximums" starting.

Dialysis or an infusion performed during a specialist office visit⁴ will be assessed the Specialist Office visit copay; the cost of the associated infused drugs will be subject to a separate cost share.

Minor surgery performed at your specialist's office will be assessed the Specialist Office visit copay. Examples of minor surgery that could be performed at a specialist's office include: mole removal, ingrown toenail correction, breast biopsy, and vasectomy.

Minor in-office procedures performed during your specialist office visit will be included in the Specialist Office visit copay. Examples include withdrawing excess fluid from a joint.

Lab work, standard radiology (e.g., X-rays) and advanced imaging (e.g., CAT scans) performed at a specialist office visit will be assessed a separate cost share.

Standard radiology includes radioisotopes, scans, sonograms, pre-admission X-ray, ultrasound, and X-rays and includes the costs associated with the image itself as well as cost associated with the provider's reading of the image. Standard radiology will follow Aetna and Cigna's individual definition of standard radiology; therefore please contact your healthcare company for a complete list.

Standard radiology performed in a PCP, Specialist and/or Inpatient hospital/Outpatient facility settings are subject to the annual deductible and coinsurance.

Visits to an urgent care facility. Please contact your healthcare company for information on in-network urgent care centers.

Connect to a doctor in minutes — anytime, anywhere — using a smartphone, phone, tablet or computer. Doctors can make diagnoses, provide advice and call in prescriptions to your local pharmacy.

Medical and Behavioral/Mental Health Virtual doctor visits are delivered through Aetna (via Teladoc) and Cigna (via MDLive). Go to My Health > Medical Specialty Services for details on how to access virtual doctor visits.