2026 CODAC Benefit Summaries and Carrier Flyers

IN-NETWORK

OUT-OF-NETWORK

Maternity:

Routine Prenatal Services: •

100% (Deductible Waived)

50%

Paid By Plan After Deductible

Non-Routine Prenatal Services, Delivery, And Postnatal Care: • Paid By Plan After Deductible

80%

50%

Outpatient Birthing Center:

No Benefit

80%

Paid By Plan After Deductible

•

Mental Health And Substance Use Disorder Benefits:

Inpatient Services / Physician Charges: • Paid By Plan After Deductible

80%

50%

Residential Treatment: •

80%

50%

Paid By Plan After Deductible

Outpatient Or Partial Hospitalization Services And Physician Charges:

No Benefit

80%

Paid By Plan After Deductible

•

Office Visit: • Oral Surgery: •

80%

50%

Paid By Plan After Deductible

80%

80%

Paid By Plan After Deductible

Physician Office Visit: • Physician Office Services: •

80%

50%

Paid By Plan After Deductible

80%

50%

Paid By Plan After Deductible

Post-Cochlear Implant Aural Therapy: • Maximum Visits Per Calendar Year

30 Visits

Post-Cochlear Implant Aural Therapy, Outpatient Hospital Only:

No Benefit

80%

Paid By Plan After Deductible

•

Post-Cochlear Implant Aural Therapy, Office Only: • Paid By Plan After Deductible

80%

50%

Note: Medical Necessity Will Be Reviewed After 30 Visits. Preventive / Routine Care Benefits. See Glossary Of Terms For Definition. Benefits Include:

Preventive / Routine Physical Exams At Appropriate Ages: • Paid By Plan After Deductible

100% (Deductible Waived)

50%

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