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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

required to provide pre-transplant evaluation, hospital and physician service

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