therapy $0 copay 
Cardiac rehabilitation $0 copay 
Pulmonary rehabilitation $0 copay 
TELEHEALTH SERVICES (in addition to Original Medicare) 
Primary care provider (PCP) $0 copay 
Specialist $0 copay 
Urgent care services  $0 copay 
Substance abuse or behavioral 
health services  $0 copay H1036235000SB23 Summary of Benefits 13 H1036235000 
Medicaid Benefit Comparison 
The benefits described in the Covered Medical and Hospital Benefits sections above are covered by