2026 CODAC Benefit Summaries and Carrier Flyers

TRANSPLANT SCHEDULE OF BENEFITS

The program for Transplant Services at Designated Transplant Facilities is:

Optum

Benefit Plan(s) ALL

Transplant Services: Designated Transplant Facility

Transplant Services: •

70%

Paid By Plan After Deductible

Travel And Housing: •

$10,000

Maximum Benefit Per Transplant

100% (Deductible Waived)

Paid By Plan

•

Travel And Housing At Designated Transplant Facility At Contract Effective Date/Pre-Transplant Evaluation And Up To One Year From Date Of Transplant.

-15-

7670-00-415125