Lab services $0 copay 
Diagnostic tests and procedures $0 copay 
Outpatient X-rays $0 copay 
Radiation therapy $0 copay 
HEARING SERVICES 
Medicare-covered hearing $0 copay 
Routine hearing HER945 
•$0 copay for routine hearing exams up to 1every year. You do not need areferral to receive covered services from plan providers. Certain procedures, services and drugs 
may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please