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BENEFITS City Health Plan PacificSource Health Plans <br />Administered by ODS Health Plans <br />Rehabilitation 80% after deductible if prescribed by Covered in full after $10 co-pay per <br />(Physical Therapy) physician. session; limited to 30 sessions/yr. <br /> (combined with Occupational & Speech <br /> Therapy). Must be preauthorized. <br />Occupational and 80% after deductible for certain medical Covered in full after $10 co-pay per <br />Speech Therapy conditions if prescribed by physician. session; limited to 30 sessions/yr. <br /> (combined with Physical Therapy). Must <br /> be preauthorized. <br />Special Provisions <br />Mental Health Benefits provided in accordance with Benefits provided in accordance with <br />Services & Chemical state and federal requirements. state and federal requirements. <br />Dependency <br />including Alcoholism <br />Emergency Care <br />Within Service Area 80% after deductible for treatment of $100 co-payment per visit; waived if <br /> illness; admitted. <br /> 80% with no deductible for treatment of <br /> accidental injury. <br />Outside of Service 80% after deductible for treatment of $100 co-payment per visit; waived if <br />Area illness; admitted. <br /> 80% with no deductible for treatment of <br /> accidental injury. <br />Emergency 80% after deductible for local $50 per trip; waived if admitted. Air <br />Transportation ambulance service. ambulance covered when preauthorized. <br />Other Medical Treatment <br />Alternate Care / Acupuncture and Chiropractor: 80% Services of Licensed Chiropractors, <br /> after deductible. Licensed Massage Therapists, <br /> / Office visits to Licensed Naturopaths Registered Acupuncturists & Registered <br /> ($300 benefit max), Licensed Massage Dieticians; and office visits to Licensed <br /> Therapists ($300 benefit max), and Naturopaths: $8 co-pay per visit, up to <br /> Registered Dietitians ($200 benefit 12 visits (12 total visits combined for all <br /> max): 80% after deductible. Benefit types of alternate care providers) per <br /> maximums per calendar year as noted. year. <br /> No limitation on number of visits. <br />Hearing Aids 50% of eligible expenses covered after 50% of eligible expenses covered up to <br /> deductible, up to a $1000 maximum a $1000 maximum benefit during a 36- <br /> benefitduring a 36-month period. month period. <br />Home Health Care Covered in full after deductible when Covered in full when preauthorized. <br /> provided by RN or registered physical <br /> therapist and prescribed by a physician. <br />CITY OF EUGENE: Summary of Benefits for AFSCME-Represented Employees (FY2005) -- Page 4 of 6 <br />