Are X-rays, Labs, and Diagnostics eligible for sharing?

Yes, they are eligible for sharing, but are shared differently depending on your Program.

If you are enrolled in a Catastrophic365 or Catastrophic Program, eligible expenses for pre- and post-inpatient hospitalization, pre- and post-outpatient surgery, and ER Visits are Eligible for sharing after the Member’s ISA is met up to the Per Incident Sharing Maximum.

For those enrolled in a Classic Program, eligible Labs or X-rays are shared under the Visit Fee ONLY if performed at the Primary Care, Specialist, or Urgent Care Facility on the same day as the visit. The Lab or X-ray is subject to the Member’s ISA if the Member has the Lab or X-ray done at a different facility or on a different day at the same facility.

Diagnostic Imaging, such as MRI, CT Scans, PET Scans, and Pathology Labs, will never be included in the Visit Fee, and the ISA will separately apply.

View our Education Video on X-Rays, Labs, & Diagnostics for more information!