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["Table 1. Coverage of Selected Benefits Within Federally Required EHB Categories"]
[]
[]
[null,"BCBS Comp Major Medical PPO","Health Advantage Open Access POS","Qual Choice","FEHBP BCBS Standard Option","FEHBP BCBS Basic Option","Qual Choice Federal Plan","State and Public School Employee Plan"]
[null,"Coverage","Coverage","Coverage","Coverage","Coverage",null,"Coverage"]
["Ambulatory Patient Services"]
["General ambulatory","Covered","Covered","Covered","Covered","Covered","Covered","Covered, office visits for physican and specialist, OP or IP"]
["Home health services","Covered","Covered","Covered","Covered, limited to 2 hours per day, 25 visits/year","Covered, limited to 2 hours per day, 25 visits/year","Covered, limit 40 visits per year","Covered, subject to coinsurance"]
["Physical/Occupational Therapy","Covered limited to 30 visits per calendar year","Covered, limited to 30 visits aggregate for OT, PT, ST, and Chiropractic","Covered, with limits on visits not specified in Evidence of Coverage","75 visits/year aggregate (OT, PT, Speech combined)","50 visits/year aggregate (OT, PT, Speech combined)","Covered, limited to 60 visits or 2 consecutive months per condition","Covered subject to coinsurance"]
["Speech Therapy","Covered, limited to 25 vists per calendar year","Covered, limited to 30 visits aggregate for OT, PT, ST, and Chiropractic","Covered, with limits on visits not specified in Evidence of Coverage","75 visits/year aggregate (OT, PT, Speech combined)","50 visits/year aggregate (OT, PT, Speech combined)","Covered, limited to 60 visits or 2 consecutive months per calendar year","Covered subject to coinsurance"]
["Chiropractic Care","Not covered","Covered, limited to 30 visits aggregate for OT, PT, ST, and Chiropractic","Covered, with limits on visits not specified in Evidence of Coverage","Covered, 12 visits per year","Covered, 20 visits per year","Covered, lifetime limit of 20 visits","Covered, limit 15 visits per plan year"]
["Acupuncture as Anesthesia","Not covered","Not covered","Not covered","Covered, 24 visits/year","Covered","Not covered, unless used as anesthesia","Not covered"]
["Weight loss programs","Not covered","Not covered","Not covered","Not covered","Not covered","Not specified","Obesity services provided through physician office visits"]
["Infertility treatment","Covered with annual dollar limit","Covered for diagnostics only","Covered for diagnostics only","Limited Coverage","Limited Coverage","Covered, with exclusions","Only testing/diagnostics, no treatment"]
["Emergency Services"]
["General services","Covered","Covered, subject to in-network deductible and coinsurance when care is received w/in 48 hrs of emergency","Covered","Covered","Covered","Covered","Covered"]
["Emergent Transportation","Covered","One trip per person per year by ground, water, air is covered, limited to $1000/trip for ground/water and $5000 for air",null,"One trip per person per year by ground, water, air is covered, limited to $1000/trip for ground/water and $5000 for air","Ground, water, air are covered, limited to $1000/trip for ground/water and $5000 for air",null,"Covered, limited to $2000 per trip for ground transportation"]
[]
["Hospitalization"]
["General hospital services","Covered","Covered","Covered","Covered","Covered","Covered","Covered"]
["Hospice","Covered when life expectancy is less than 6 months","Covered when life expectancy is less than 6 months","Covered, with limits not specified","Covered","Covered","Covered","Covered, subject to coinsurance"]
["Skilled nursing facility","Covered, limited to 30 days per calendar year if admitted within 7 days of release from hospital","Covered, limited to 30 days per calendar year if admitted within 7 days of release from hospital","Covered, with limits not specified","Covered (limited to members with Medicare Part A)","Not covered","Covered, limited to 60 days per calendar year","Covered, subject to coinsurance and copayment"]
["Bariatric Surgery","Covered with per treatment dollar limits","Not covered","Not covered","Covered","Covered","Covered","Covered through pilot program only"]
["Maternity and Newborn Care"]
["Maternity services","Covered, including certified nurse midwives","OB and newborn care covered; midwives not covered","Covered","Covered","Covered","Covered","Covered, including pre- and post-natal OP care"]
[]
["Mental Health and Substance Use Disorder"]
["Inpatient treatment - psychiatric / SA","Covered, limited to 7 days per year and restricted to care in a hospital setting","7 days per year","Offered under MH Parity rider","Covered","Covered","Covered for approved treatment programs only","covered, including residential and IP"]
["Outpatient treatment - psychiatric / SA","Covered, limited to 30 visits and restricted to care in a hospital setting","Covered","Offered under MH Parity rider","Covered","Covered","Covered for approved treatment programs only","covered, including day treatment"]
["Substance Abuse - addiction / alcoholism","Covered, substance abuse treatment has lifetime limit of 2 admissions","Covered","Offered under MH Parity rider",null,null,"Covered for approved treatment programs only","covered"]
["Prescription Drugs"]
[null,"Covered with 3 tier formulary","Offered through Rx Rider","Covered","Covered","Covered","Covered","Covered, three tiers plus OTC program with copays"]
["Rehabilitative / habilitative services and devices"]
["Durable Medical Equipment","Covered","Covered","Covered, with annual dollar limits","Covered","Covered","Covered","Covered, subject to coinsurance"]
["Hearing Aids","Generally not covered, auditory implants only","Generally not covered, auditory implants only","Generally not covered, auditory implants only","Covered with dollar limits per ear","Covered with dollar limits per ear","Covered","Covered with dollar limit per ear every three years"]
["Habilitative Services and Devices","PT/OT/ST includes coverage for therapy related to developmental delay","PT/OT/ST includes coverage for therapy related to developmental delay.  However, maintenance therapy is excluded","Generally not covered, PT/OT/ST covered for rehabilitative purposes only","PT/OT/ST covered, excluding maintenance or palliative therapy, limited to 75 visits","PT/OT/ST covered, excluding maintenance or palliative therapy, limited to 75 visits","Not covered, PT/OT/ST for rehabilitation only","PT/OT/ST covered for developmental delay"]
["Traumatic Brain Injury (TBI)","Covered","Rehab facility covered if admitted w/in 7 days of release","Not specified","Not specified","Not specified","Not specified","Not specified"]
["Laboratory Services"]
[null,"Coverd","Covered","Covered","Covered","Covered","Covered","Covered, additional charges apply for MRI, MRA, CTA, and PET Scans"]
["Preventive and Wellness Services, CD Management"]
["Chronic Management","Diabetes management is covered, limited to one management training program per lifetime, one eye exam per calendar year, and associated DME","One Diabetes Management Training Program/lifetime",null,"Covered","Covered","Covered","Diabetes management"]
[null,"Preventive Health Services are covered","Preventative Health Services are covered","Preventive Health Services are covered","Preventative Health Services Covered","Preventative Health Services Covered","Preventive Health Services covered","Preventive Health Services covered"]
[null,null,null,"Routine vision exam is covered",null,null,"Routine vision exam is covered","Allergy testing is covered"]
["Pediatric Services, including oral and vision care"]
[null,"Covered children's preventive services include oral and vision assessments. Other vision only covered as a result of accident or injury. Dental is generally not covered unless a child under age 7 requires immediate dental care in a hospital setting.","Vision is only covered as a result of accident or injury.  Dental is generally not covered.","Not specified, dental is generally not covered except under a rider.  Vision is generally only covered as a result of accident or injury","Dental covered according to charge schedule, optional vision plan available to plan members","Dental covered according to charge schedule, optional vision plan available to plan members","Dental covered for accident and injury only, available under FEDVIP.  Vision also available through FEDVIP.","Covered children's preventive services include oral and vision assessments.  Other dental only covered for accident or injury"]

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