2026 CODAC Benefit Summaries and Carrier Flyers

TRANSPLANT SCHEDULE OF BENEFITS

Benefit Plan(s) 003 – HDHP 3400 Plan

Transplant Services At A Designated Transplant Facility:

Transplant Services: •

80%

Paid By Plan After Deductible

Travel And Housing: •

$10,000

Maximum Benefit Per Transplant Paid By Plan After Deductible

100%

•

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

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7670-00-412271