Magnolia Health PlanBenefit Chart
Magnolia Benefits Chart
| Covered Services: | Benefit Limits |
|---|---|
| Ambulatory Surgical Center Services | |
| Chiropractic Services | $700/year max |
| Dental Services | Adult/Child Routine Dental: $2,500 / year Child Orthodontia: $4,200 / lifetime |
| Durable Medical Equipment | |
| Emergency Room Services | 6 visits per year |
| EPSDT and Expanded EPSDT Services | |
| Eye exam and eye glasses | 1 per year |
| Family Planning Services | |
| Federally Qualified Health Centers Services | |
| Freestanding Dialysis Center Services | |
| Home Health Services | 25 visits per year |
| Hospice Services | |
| Laboratory and X-Ray Services | |
| Nurse Midwife Services | |
| Nurse Practitioner Services (Pediatric and Family) | |
| Nutritional/Dietician Consult | |
| Outpatient Hospital Services | |
| Doctor Office Visits | No Limits |
| Podiatrist (foot doctor) Services | |
| Prescription Drugs | 6 per month (Maximum 2 Brand Drugs) |
| Rural Health Clinic Services | |
| State Department of Health Clinic Services | |
| Transportation Services |