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Persons: 1 |
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Outpatient Services |
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Individual ? | |||||||
Family ? | |||||||
Preventive Services |
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General Practitioner / PCP ? | |||||||
Specialist ? | |||||||
Subspecialist ? | |||||||
Nutritionist ? | |||||||
Chiropractor ? | |||||||
Outpatient Facility ? | |||||||
Prescribed Medical Equipment (DME) ? | |||||||
Laboratory, X-Ray, Specialized and Imaging |
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Preventive Services ? | |||||||
Emergency/Urgent Care Services |
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Laboratories ? | |||||||
X-Rays ? | |||||||
Sonogramas, CT, MRI ? | |||||||
Hospitalization/Inpatient |
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Urgent Care Services ? | |||||||
Emergency Services: Accident / Illness ? | |||||||
Surgical Assistant |
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Hospitalization/Inpatient Partial (Including Mental Health) ? | |||||||
Hospitalization/Inpatient Complete (Including Mental Health) ? | |||||||
Skilled Nursing Facility ? | |||||||
Emergency Services in the United States or Services in Cases that Require Equipment, Treatment and Facilities That Are Not Available In Puerto Rico. |
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Surgical Assistant ? | |||||||
Vision |
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Emergency Services in the United States or Services in Cases that Require Equipment, Treatment and Facilities That Are Not Available In Puerto Rico. ? | |||||||
Urgent Care Services in the United States - Sanitas ? | |||||||
Dental Coverage |
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Refraction Test (Vision for Children and Adults) ? | |||||||
Pediatric Vision (Visual Correction Lenses or Frames for Visual Correction Lenses) ? | |||||||
Glasses or Contact Lenses for Adults ? | |||||||
Pharmacy Coverage |
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Preventive and Diagnostic ? | |||||||
Other Services |
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Drug List ? | |||||||
Annual Deductible ? | |||||||
First Level of Coverage ? | |||||||
Generics ? | |||||||
Preferred Brand ? | |||||||
Non-preferred Brand ? | |||||||
Preferred Specialty ? | |||||||
Non-preferred Specialty ? | |||||||
Over The Counter Drugs (OTC) ? | |||||||
Coinsurance After First Level of Coverage ? |