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Telehealth 0 <br />■ $30 copay for Urgently Needed <br />Education <br />Services <br />(Authorization <br />■ $25 copay for Primary Care Services <br />applies to in- <br />■ $35 copay for Occupational <br />network <br />Therapy/Physical Therapy/Speech <br />services only) <br />Therapy at all locations <br />■ $45 copay for Dermatology Services <br />■ $40 copay for individual sessions for <br />outpatient Mental Health Specialty <br />Services <br />• $40 copay for individual sessions for <br />SilverSneakers® <br />outpatient Psychiatry Specialty <br />Fitness <br />Services <br />Program <br />■ $40 copay for Opioid Treatment <br />Program Services <br />■ $40 copay for individual sessions for <br />outpatient Substance Abuse <br />Specialty Services in an office setting <br />• $0 copay for Diabetes Self - <br />Management Training <br />■ $0 copay for Dietician Services <br />■ 40% of the Medicare -allowed amount <br />after $2,000 out -of -network <br />deductible <br />Health <br />meQuilibrium's digital coaching Not Available <br />Education <br />platform delivers clinically validated <br />and highly personalized resilience <br />solutions to help people improve <br />their ability to manage stress and <br />successfully cope with life's <br />challenges. To get started visit <br />www.floridablue.com/medicare <br />to log in to My Health LinkT"', your <br />member portal. Select "My Health <br />Center" then "meQuilibrium". <br />SilverSneakers® <br />■ Gym membership and classes Not Available <br />Fitness <br />available at fitness locations <br />Program <br />across the country, including <br />national chains and local gyms. <br />■ Access to exercise equipment <br />and other amenities, classes for <br />all levels and abilities, social <br />events, and more. <br />12 338 <br />