Summary Plan Description
80% Network and Non-Network
Benefits are provided for chiropractic care for the manipulation of the spine and supporting structures with a calendar year maximum of 24 visits. These services always require 20 percent coinsurance and these coinsurance expenses do not apply toward the $2,300 annual coinsurance maximum or $4,000 out-of-pocket maximums. Services and supplies include:
- Initial office call and evaluation per spinal condition.
- Initial plane film diagnostic x-rays of the spine per condition performed or ordered for chiropractic care.
- Spinal manipulations.
Benefits are not provided for:
- Manipulations of any parts of the body which are not articulations of the spine.
- Treatment which is not within the scope of the covered provider's license.
- Office calls in addition to spinal manipulations on the same day, except as provided above.
- Physical therapy or modalities.
- Massage therapy.
- Treatment by machine including, but not limited to, vibrasonic therapy, ultrasound therapy, hydrotherapy.
Related Health & Security Content
- 2017 Summary of Material Modifications (1/31/2017)
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- 2016 Summary of Material Modifications
- 2014 Summary of Material Modifications
2017 Summary of Benefits and Coverage
Delta Dental of Washington
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