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In -Network <br />• Prostate cancer screening <br />exams <br />• Screening and counseling to <br />reduce alcohol misuse <br />• Screening for lung cancer with <br />low dose computed <br />tomography (LDCT) <br />• Screening for sexually <br />transmitted infections (ST1s) <br />and counseling to prevent STIs <br />• Smoking and tobacco use <br />cessation (counseling to stop <br />smoking or tobacco use) <br />• Vision care: Glaucoma <br />screening <br />• "Welcome to Medicare" <br />preventive visit <br />Emergency Care Medicare -Covered Emergency Care <br />■ $75 copay per visit, in- or out -of -network <br />Out -of -Network <br />This copay is waived if you are admitted to the hospital within 48 hours of an <br />emergency room visit, <br />Worldwide Emergency Care Services <br />■ $75 copay for Worldwide Emergency Care <br />■ $25,000 combined yearly limit for Worldwide Emergency Care and <br />Worldwide Urgently Needed Services <br />Does not include emergency transportation. <br />Urgently Needed Medicare -Covered Urgently Needed Services <br />Services Urgently needed services are provided to treat a non -emergency, unforeseen <br />medical illness, injury or condition that requires immediate medical attention. <br />■ $30 copay at an Urgent Care Center, in- or out -of -network <br />Convenient Care Services are outpatient services for non -emergency injuries <br />and illnesses that need treatment when most family physician offices are <br />closed. <br />■ $30 copay at a Convenient Care Center, in- or out -of -network <br />Worldwide Urgently Needed Services <br />■ $75 copay for Worldwide Urgently Needed Services <br />.. .... ......... .... .. <br />0 <br />