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Note: when services are furnished by a non-network hospital-based radiologist at any network hospital, the Atrius Health Ecosystem provider cost share applies.

The member's office visit copayment is waived when medical care services are furnished at a hospital (unless the provider's office is located at or professional charges are billed by the hospital). However, for hospital medical care services, the deductible will apply.

Routine sigmoidoscopies, barium enemas and colonoscopies.

Note: The selected hospitals in the Standard Benefits Tier for which the lower copayment applies include: Athol Memorial Hospital, Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Falmouth Hospital, Martha's Vineyard Hospital, Nantucket Cottage Hospital, and North Adams Regional Hospital.

Note: The lowest Enhanced Tier copayment amount will apply to all Tiers when nurse practitioner, physician assistant, or nurse midwife medical care services are not billed by a physician.

Note: These oral surgery benefits also include removal of impacted teeth that are fully or partially imbedded in the bone, removal of seven or more teeth (includes wisdom teeth), and gingivectomies involving two or more gum quadrants, when the member has a serious medical condition that requires admission to a Surgical Day Care Unit of a hospital or to an Ambulatory Surgical Facility in order for the surgery to be safely performed.

Termination of pregnancy (abortion) only when: the member suffers from a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the pregnancy, that would, as certified by a physician, place the member in danger of death unless the abortion is performed; or the pregnancy is the result of an act of rape or incest.

Termination of pregnancy (abortion) only when: the member suffers from a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the pregnancy, that would, as certified by a physician, place the member in danger of death unless the abortion is performed; or the pregnancy is the result of an act of rape or incest.

One visit each group plan year for ages 3 through 18.

This health plan also covers foot orthotics, including arch supports, shoe (foot) inserts and orthopedic and corrective shoes (whether or not they are part of a leg brace).