| Service/Feature | HSA | PPO | | ----------------------------------------------------------- | ---------------------------------------------------------- | ------------------------------------------------------------------------------------------------------ | | **Visit & Treatment Limits** | | | | Physical/Occupational/Speech Therapy Combined | 30 visits per year | 60 visits per year | | Chiropractic Care | 12 visits per year | 24 visits per year | | Skilled Nursing Care | 90 days per year | 120 days per year | | **Emergency & Urgent Care** | | | | Emergency Transportation | 100% after deductible; mileage limits apply | 100% after deductible; mileage limits apply | | Urgent Care | 100% after deductible; 80% after out-of-network deductible | $20 copay in-network; 20% after out-of-network deductible | | **Prescription Drug Coverage** | | | | When Copays Apply | After deductible is met | Immediately, no deductible requirement | | Copay Structure (Generic/Preferred/Non-Preferred/Specialty) | After deductible: $5/$25/$50/$50 | From start: $5/$25/$50/$50 | | **Out-of-Network Coverage** | | | | Deductible (Individual/Family) | $3,300/$6,600 | $1,000/$2,000 | | Coinsurance | 20% after deductible | 20% after deductible | | **Additional Service Differences** | | | | Private Duty Nursing | 100% after deductible | 70% in-network / 50% out-of-network after deductible | | Mental Health/Substance Use Disorder | Must use participating facilities for outpatient services | Out-of-network coverage available (20% coinsurance) | | Applied Behavior Analysis (ABA) | Covered same as in-network for both networks | $20 copay in-network; 20% after deductible out-of-network; must use approved licensed behavior analyst | | Mental Health Service Location | Cost share varies by service location | Outpatient services covered at participating facilities only | | Occupational Therapy | Included in combined 30-visit therapy limit | Separate limits beyond combined physical/speech therapy |