3 Type of Service Plan Pays In - Network Plan Pays Out - of - Network Malignancy Treatment 30% after deductible 50% after deductible Organ Transplant – Paid like any other illness See applicable service 50% after deductible Outpatient Rehabilitative Therapy Speech, physical, occupational, cardiac, etc. Limit: Maximum of 50 days of treatment per calendar year for all covered therapies 30% after deductible 50% after deductible Podiatry Care Limit: Maximum of 30 days/calendar year 30 % after deductible 50% after deductible Pre - Admission Testing 30% after deductible 50% after deductible Prosthetics/Orthotics 100% after $50 copay / item 50% after deductible Radiation Therapy 30 % after deductible 50% after deductible Skilled Nursing Facility Limit: Maximum of 100 days of treatment per calendar year 30 % after deductible 50% after deductible MENTAL HEALTH CARE Inpatient 30 % after deductible 50% after deductible Outpatient Facility 30 % after deductible 50% after deductible Outpatient Visit 30 % after deductible 50% after deductible SUBSTANCE ABUSE TREATMENT Inpatient Hospital 30 % after deductible 50% after deductible Outpatient Facility 30 % after deductible 50% after deductible Outpatient Visit 30 % after deductible 50% after deductible