2026 CODAC Benefit Summaries and Carrier Flyers

IN-NETWORK

OUT-OF-NETWORK

Ambulance Transportation: • Paid By Plan After In-Network Deductible Augmentation Communication Devices: • Maximum Benefit Every 3 Years

80%

80%

1 Device

80%

50%

Paid By Plan After Deductible

•

Breast Pumps: •

100% (Deductible Waived)

50%

Paid By Plan After Deductible

Cardiac Pulmonary Rehabilitation: • Maximum Visits Per Calendar Year

20 Visits

Cardiac Pulmonary Rehabilitation Outpatient Hospital Only:

No Benefit

80%

Paid By Plan After Deductible

•

Cardiac Pulmonary Rehabilitation Office Only: • Paid By Plan After Deductible

80%

50%

Note: Medical Necessity Will Be Reviewed After 20 Visits. Cardiac Rehabilitation Phase 1 & 2: • Maximum Visits Per Calendar Year

36 Visits

Cardiac Rehabilitation Phase 1 & 2 Outpatient Hospital Only:

No Benefit

80%

Paid By Plan After Deductible

•

Cardiac Rehabilitation Phase 1 & 2 Office Only: • Paid By Plan After Deductible

80%

50%

Note: Medical Necessity Will Be Reviewed After 36 Visits. Cognitive Rehabilitation Therapy: • Maximum Visits Per Calendar Year

20 Visits

Cognitive Rehabilitation Outpatient Hospital Therapy Only:

No Benefit

80%

Paid By Plan After Deductible

•

Cognitive Rehabilitation Office Therapy Only: • Paid By Plan After Deductible

80%

50%

Note: Medical Necessity Will Be Reviewed After 20 Visits.

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