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Medicare Part D (Tier 1, Tier 2 covered drugs)

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11155

Medicare Part D (Tier 3, Tier 4 covered drugs)

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11156

Bone densitometry testing

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11157

Designated PCP or OB/GYN physician, nurse practitioner, physician assistant, nurse midwife services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11162

Family or general practitioner, internist, pediatrician, geriatric specialist services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11163

Nurse practitioner, physician assistant, nurse midwife services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11164

Travel immunizations

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11165

Diagnostic colonoscopy, sigmoidoscopy, barium enema

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11166

Infertility Center of Excellence - facility services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11170

Other network providers

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

11172