Cost-share for x-rays or labs performed in a PCP office and billed by the PCP. In some benefit designs, particularly co-payment-oriented designs, the office-visit co-pay might cover any labs or x-rays incurred at the time of the office visit. If this is the case, select No Charge in the benefit design drop-down list for this category. This information should be clear in a full SBC, but might not be in an abbreviated benefit summary.
The following five benefit service categories are all found in the same section of the SBC, “If you have a test”:
- Lab Outpatient Facility
- Lab Outpatient Professional Office
- X-Rays Primary
- X-Rays Specialist
- X-Rays All Other
Sometimes all five categories have the same benefit design, in which case you should enter the same information for all of them. Sometimes, however, there is differentiation based on labs vs. x-rays, and / or place-of-service (PCP vs. Specialist vs. free-standing vs. facility). When there is differentiation, it will be described in the detail of the “If you have a test” section of the SBC: