2025-2026 EAA Benefits Guide

Facility Fee

Out-Patient Ambulatory Surgery Center In-Patient Hospital Room Extended Care Services Home Health Care

100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible

30% coinsurance

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

Skilled Nursing Facility

No Charge; deductible does not apply

Hospice Care

50% coinsurance

30% coinsurance

Mental Health/Behavior Health/ Substance Abuse Services (Certain services must be preauthorized) Inpatient Services 30% coinsurance 50% coinsurance

30% coinsurance

Outpatient Services (Office Visits) All other outpatient services

$50 copay/visit

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

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