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and urgent care centers covered by the hospital contract will be $40.

Charges for outpatient surgery services covered by the hospital contract

will be subject to a $40 copayment per outpatient visit. Effective January
1, 2019, the copayment for outpatient surgery services covered by the

hospital contract will be $75. These hospital outpatient copayments will be
waived for persons admitted to the hospital as an inpatient directly from

the outpatient setting, and for the following covered chronic care outpatient
services; chemotherapy, radiation therapy, or hemodialysis. The

copayment for pre-admission testing/pre-surgical testing prior to an
inpatient admission will be waived. Hospital outpatient physical therapy

visits will be subject to the same copayment in effect for physical therapy
visits under the Managed Physical Network Program.

(c) Current coverage for services provided in the outpatient department
of a hospital will be expanded to include services provided in a remote

location of the hospital (hospital owned and operated extension clinics).
Emergency care provided in such remote location of the hospital will be

subject to the $60 copayment. Effective January 1, 2019, the copayment
for emergency care provided in such remote location of the hospital will be

$90. Charges for outpatient laboratory and diagnostic services and urgent
care center visits provided in such remote location of the hospital will be

subject to a $30 copayment. Effective January 1, 2019, the copayment for
outpatient laboratory and diagnostic services and urgent care centers

provided in such remote location of the hospital will be $40. Outpatient
surgery services provided in such remote location of the hospital will be

subject to a $40 copayment per outpatient visit. Effective January 1, 2019,
the copayment for outpatient surgery in a remote location of the hospital

will be $75.
(d) Charges for the attending hospital emergency room physician and

providers who administer or interpret radiological exams, laboratory tests,

electrocardiograms and pathology services directly associated with the
covered hospital emergency room care for a medical emergency will be
reimbursed under the participating provider or the basic medical program

not subject to deductible or coinsurance when such services are not

included in the hospital facility charge.
(e) The Empire Plan will continue to provide a voluntary "Centers of

Excellence Program" for organ and tissue transplants. The Centers will be

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