| *Standard Population Limited Hospital Benefit Code List **Standard Benefit Package Limitations (OAR 410-122-0055) 1Specific criteria must be met 2Coverage only available to children and pregnant women on OHP Plus |
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| Covered service | OHP Plus | OHP Standard |
|---|---|---|
| Acupuncture | X | Chemical dependency only |
| Ambulatory surgical center | X | X |
| Audiology | X | Diagnostic exams only |
| Bariatric surgery1 | X | |
| Chemical dependency | X | Outpatient only |
| Chiropractic & osteopathic manipulation | X | |
| Dental | X | Limited emergency only |
| Emergent/urgent care | X | X |
| Hearing aids & exams | X | |
| Home health | X | |
| Hospice | X | X |
| Hospital care | X | Limited* |
| Immunizations | X | X |
| Laboratory services | X | X |
| Medical equipment & supplies | X | Limited** |
| Medical transportation | X | Emergency only |
| Occupational therapy | X | |
| Physical oherapy | X | |
| Physician services | X | X |
| Prescription drugs | X | X |
| Private duty nursing | X | |
| Speech therapy | X | |
| Non-routine vision care | X | X |
| Routine vision care2 | X | |
| X-rays | X | X |