2026 CODAC Benefit Summaries and Carrier Flyers

IN-NETWORK

OUT-OF-NETWORK

Hearing Services:

Exams, Tests: •

80%

50%

Paid By Plan After Deductible

Hearing Aids: • Maximum Benefit Including Implantable Hearing Devices

1 Per Ear Every 3 Years

80%

50%

Paid By Plan After Deductible

•

Implantable Hearing Devices: •

Included In Hearing Aids Maximum Paid By Plan After Deductible

80%

50%

•

Home Health Care Benefits: •

60 Visits

Maximum Visits Per Calendar Year Paid By Plan After Deductible

80%

50%

•

Note: A Home Health Care Visit Will Be Considered A Periodic Visit By A Nurse, Qualified Therapist, Or Qualified Dietician, As The Case May Be, Or Up To Four Hours Of Home Health Care Services. Hospice Care Benefits: • Paid By Plan After Deductible

80%

50%

Hospital Services:

Pre-Admission Testing: •

80%

50%

Paid By Plan After Deductible

Inpatient Services / Inpatient Physician Charges; Room And Board Subject To The Payment Of Semi-Private Room Rate Or Negotiated Room Rate: • Paid By Plan After Deductible

80%

50%

Outpatient Services / Outpatient Physician Charges:

No Benefit

80%

Paid By Plan After Deductible

•

Outpatient Imaging Charges:

No Benefit

80%

Paid By Plan After Deductible

•

Outpatient Lab And X-Ray Charges:

No Benefit

80%

Paid By Plan After Deductible

•

Outpatient Surgery / Surgeon Charges:

No Benefit

80%

Paid By Plan After Deductible

•

Physician Clinic Visits In An Outpatient Hospital Setting:

No Benefit

80%

Paid By Plan After Deductible

•

Manipulations: •

20 Visits

Maximum Visits Per Calendar Year Paid By Plan After Deductible

80%

50%

•

Note: Medical Necessity Will Be Reviewed After 20 Visits.

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7670-00-412271