transportation  Covered Covered 
Skilled nursing facility  Covered Covered 
Urgently needed services  Covered Covered H5619075000SB23 Summary of Benefits 15 H5619075000 
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 
every limitation or exclusion. The Evidence of Coverage (EOC) provides acomplete list of