limited up to  $1,000 per year and must 
be coordinated and authorized by acare 
manager. There is no cost to participate.   
Acupuncture 
$0 copay for acupuncture visits up to 12 
visit(s) per year. 
Chiropractic services 
Routine chiropractic: 
$0 copay per visit for up to 12 visits. 16 Summary of Benefits H1036235000SB23 H1036235000 
Smoking cessation program 
To further assist in your effort to quit 
smoking or tobacco product use, we 
cover one additional counseling quit