| Service |
Coverage |
Authorization Requirements |
Co-Pay: Active duty dependents & retirees with Medicare Part B |
Co-Pay: Retirees without Medicare Part B |
| Obstetrical Care |
Covered |
No |
No |
No |
| Occupational Therapy, home care |
Covered |
Yes |
No |
Yes |
| Occupational Therapy, inpatient |
Covered |
Yes |
No |
No (included under admission) |
| Occupational Therapy, outpatient |
Covered |
Contact Orthonet |
No |
Yes |
| Open MRI |
Covered |
Yes |
No |
No |
| Oral Surgery |
Limited |
Yes |
No |
Yes |
| Orthodonia |
Not covered |
N/A |
N/A |
N/A |
| Orthotic, Cranial |
Limited |
Yes |
No |
Yes |
| Orthotics |
Limited |
Yes - depends on item |
No |
Yes |
| Orthotics, Diabetic |
Covered |
Yes |
No |
Yes |
| Orthotics, Foot |
Limited |
Yes |
No |
Yes |
| Ostomy Supplies |
Covered |
No |
No |
Yes |
| Out of Geographic Service Area, Hosptial Based Emergency Department Care |
Covered |
No |
No |
Yes |
| Out of Geographic Service Area, routine healthcare services |
Limited - Healthcare services requested must be part of a pre-established/active treatment plan |
Yes |
No |
Yes (depends on service type) |
| Out of Geographic Service Area, Urgent Care (hospital based or free standing urgicare center) |
Covered |
No |
No |
Yes |
| Out of Geographic Service Area, Urgent Care (private physician office) |
Covered |
Yes |
No |
Yes |
| Out of Network healthcare services |
Limited |
Yes |
No |
Yes |
| Over the Counter Medications (OTC medications) |
Not covered |
N/A |
N/A |
N/A |
| Overbed Table |
Not Covered |
N/A |
N/A |
N/A |
| Oxygen Equipment, Stationary and Portable |
Covered |
Obtain from Apria |
No |
Yes |
