The preventive care services are covered at 100% in-network by the Simplified 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 health care 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. JPMorgan Chase does not make this determination.

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 copay.

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.

Outpatient mental health/substance use therapy includes office visits with: Psychologists, Clinical Social Workers, Drug and Alcohol Counselors, Licensed Professional Counselors, Marriage/Family Therapists, Behavioral Health Nurse Practitioners, and Psychiatric Nurses. Please Note: An office visit with a psychiatrist is considered a Specialist Office Visit.

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 copay.

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).

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.

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.

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 health care company for a complete list.

Standard radiology performed in a PCP, Specialist and/or Outpatient settings will be assessed this separate copay amount. Standard radiology performed as part of an inpatient hospital stay or emergency room (ER) visit will not be assessed this separate copay, instead it will be included in the inpatient or ER copay.

Visits to an urgent care facility. Please contact the health care companies for information on in-network urgent care centers.

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

Dialysis or an infusion performed during a specialist office visit⁴ will be assessed the Specialist Office visit copay; this copay is inclusive of the costs of the associated infused drugs.

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 includes: mole removal, ingrown toenail correction, breast biopsy, and vasectomy.

Minor in-office procedures performed during your specialist office visit such injections into a joint (knee, shoulder, elbow) will be included in the Specialist Office visit copay. Examples include pain relieving steroid injection, knee gel (e.g., Synvisc) or 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 copay.

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. (This is not meant to be an exhaustive list of services performed outpatient.)

The Outpatient Procedure/Surgery copay includes fees related to professional services (e.g., doctor or surgeon costs) and the facility charges (e.g., cost of the center itself).

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 copay.

Dialysis or an infusion performed during at an outpatient facility visit⁵ will be assessed the Outpatient Procedure/Surgery copay; this copay is inclusive of the costs of the associated infused drugs.

Durable medical equipment (DME) and supplies ordered or provided by a Physician. DME equipment/supplies or other items covered at the DME copay 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 DMEs, 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.

Advanced imaging includes CAT Scan, MRI, and PET scans. This copay includes 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 Outpatient settings will be assessed this separate copay amount. Advanced imaging performed as part of an inpatient hospital stay or emergency room (ER) visit will not be assessed this separate copay, instead it will be included in the inpatient or ER copay.

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.