contract year will be covered. 
EMERGENCY CARE 
Emergency room 
If you are admitted to the 
hospital within 24 hours, you do 
not have to pay your share of the 
cost for the emergency care. $0 copay 
Urgently needed services 
Urgently needed services are  
provided to treat a non-emergency,  
unforeseen medical illness, injury or  
condition that requires immediate  
medical attention.$0 copay 
DIAGNOSTIC SERVICES, LABS AND IMAGING 
Diagnostic mammography $0 copay 
Diagnostic radiology $0 copay