Preventive care (e.g., flu 
vaccine, diabetic screenings) Covered Covered 
Routine non-emergency medical 
transportation  Covered Covered 
Skilled nursing facility  Covered Covered 
Urgently needed services  Covered Covered H1036235000SB23 Summary of Benefits 15 H1036235000 
More benefits with  your plan 
Enjoy some of these extra benefits included in your plan . 
This is asummary of what we cover. It doesn't list every service that we cover or list