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22 <br /> Category Personal Care Plan Healthsource Plan <br /> Substance Abuse <br /> Outpatient Fully covered for 20 visits $20 copayment <br /> Detoxification No limit on days $20 copayment <br /> Inpatient Fully covered for up to 20%copayment if <br /> 30 days per year fully confined <br /> Day Treatment <br /> Facility 15%copayment <br /> Eye Care <br /> Routine Eye Exams $10 copayment $20 copayment <br /> Providers Optometrist Optometrist <br /> Ophthalmologist <br /> Eyeglasses Not covered Not covered <br /> 20%discount on complete <br /> pair if purchased from a <br /> participating doctor <br /> Cardiac <br /> Rehabilitation Fully covered for 30 visits per year Copayment based on place <br /> per type of therapy based on place of service <br /> of service Up to 6 months per year <br /> Private Duty Nursing Fully covered Fully covered to 60 days <br /> per year <br /> Skilled Nursing Fully covered for 100 days per year Fully covered <br /> Facility 100 days per year <br /> 200 days lifetime <br /> Chiropractic Covered if authorized by primary Not covered <br /> care physician and approved by <br /> the plan(see short term therapy) <br />