2026 CODAC Benefit Summaries and Carrier Flyers

IN-NETWORK

OUT-OF-NETWORK

In Addition, The Following Preventive / Routine Services Are Covered For Women: ➢ Treatment For Gestational Diabetes ➢ Papillomavirus DNA Testing* ➢ Counseling For Sexually Transmitted Infections (Provided Annually)* ➢ Counseling For Human Immune-Deficiency Virus (Provided Annually)* ➢ Breastfeeding Support, Supplies, And Counseling ➢ Counseling For Interpersonal And Domestic Violence For Women (Provided Annually)*

100% (Deductible Waived)

50%

Paid By Plan After Deductible

•

*These Services May Also Apply To Men. Sterilizations:

No Benefit

For Men: •

80%

Paid By Plan After Deductible

For Women: •

100% (Deductible Waived)

Paid By Plan

Teladoc Health Services:

24/7 Care: •

80% (Deductible Waived)

Paid By Plan

Dermatology: •

80% (Deductible Waived)

Paid By Plan

Mental Health: •

80% (Deductible Waived)

Paid By Plan

Telehealth:

No Benefit

80% (Deductible Waived)

Paid By Plan

•

Therapy Services:

Occupational Outpatient Hospital And Office Therapy: • Maximum Visits Per Calendar Year

20 Visits

No Benefit

Occupational Outpatient Hospital Only:

80%

Paid By Plan After Deductible

•

Occupational Outpatient Office Therapy Only: • Paid By Plan After Deductible

80%

50%

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