Note 1: While Rothman physicians participate in the DVACO Network, the Riddle Surgical Center (Rothman at Riddle), located in Riddle Health Center 4, IS NOT a Participating Facility. Facility charges in the form of co-pays and deductibles will apply.

Note 2: Some DVACO Network participating providers perform procedures in their own non-participating facilities where you will incur a higher facility charge. For the lower out-of-pocket DVACO level of coverage, the procedure must be done in an DVACO Network Participating facility. The Paoli Surgery Center located adjacent to Paoli Hospital, as well as Bryn Mawr Hospital's ASC, Nemours Pediatric in Bryn Mawr, and FiCare are examples of non-participating DVACO facilities physicians may use. Discuss with your physician the options for having your procedure done in a participating facility.

Note 3: Main Line Health Laboratories (MLHL) is a member of DVACO and lab fees are reimbursed 100% with no deductible. You may use any of MLHL's convenient locations in the MLH service area. Use of MLHL helps support the Main Line Health System and provides your physician with the highest quality results in the least amount of time. Please Note: LabCorp (also reimbursed at 100%) is available as an alternative service provider for those who may live outside our DVACO service area.

Note 4: There are no Durable Medical Equipment participating providers in the DVACO Network. Please review your benefits enrollment material for more information about the Durable Medical Equipment coverage available to you under the medical plan.

Note 5: Not all anesthesia providers in DVACO non-home facilities are DVACO providers and you may incur a higher member responsibility. For example, Wills Eye has satellite surgery centers outside of their center city Philadelphia main campus that may not use DVACO anesthesia providers. If services are provided by a non-home DVACO anesthesia provider the member will incur higher out of pocket expenses for those services.

Note 1: While Rothman physicians participate in the DVACO Network, the Riddle Surgical Center (Rothman at Riddle), located in Riddle Health Center 4, IS NOT a Participating Facility. Facility charges in the form of co-pays and deductibles will apply.

Note 2: Some DVACO Network participating providers perform procedures in their own non-participating facilities where you will incur a higher facility charge. For the lower out-of-pocket DVACO level of coverage, the procedure must be done in an DVACO Network Participating facility. The Paoli Surgery Center located adjacent to Paoli Hospital, as well as Bryn Mawr Hospital's ASC, Nemours Pediatric in Bryn Mawr, and FiCare are examples of non-participating DVACO facilities physicians may use. Discuss with your physician the options for having your procedure done in a participating facility.

Note 3: Main Line Health Laboratories (MLHL) is a member of DVACO and lab fees are reimbursed 100% with no deductible. You may use any of MLHL's convenient locations in the MLH service area. Use of MLHL helps support the Main Line Health System and provides your physician with the highest quality results in the least amount of time. Please Note: LabCorp (also reimbursed at 100%) is available as an alternative service provider for those who may live outside our DVACO service area.

Note 4: There are no Durable Medical Equipment participating providers in the DVACO Network. Please review your benefits enrollment material for more information about the Durable Medical Equipment coverage available to you under the medical plan.

Note 5: Not all anesthesia providers in DVACO non-home facilities are DVACO providers and you may incur a higher member responsibility. For example, Wills Eye has satellite surgery centers outside of their center city Philadelphia main campus that may not use DVACO anesthesia providers. If services are provided by a non-home DVACO anesthesia provider the member will incur higher out of pocket expenses for those services.

Note 1: While Rothman physicians participate in the DVACO Network, the Riddle Surgical Center (Rothman at Riddle), located in Riddle Health Center 4, IS NOT a Participating Facility. Facility charges in the form of co-pays and deductibles will apply.

Note 2: Some DVACO Network participating providers perform procedures in their own non-participating facilities where you will incur a higher facility charge. For the lower out-of-pocket DVACO level of coverage, the procedure must be done in an DVACO Network Participating facility. The Paoli Surgery Center located adjacent to Paoli Hospital, as well as Bryn Mawr Hospital's ASC, Nemours Pediatric in Bryn Mawr, and FiCare are examples of non-participating DVACO facilities physicians may use. Discuss with your physician the options for having your procedure done in a participating facility.

Note 3: Main Line Health Laboratories (MLHL) is a member of DVACO and lab fees are reimbursed 100% with no deductible. You may use any of MLHL's convenient locations in the MLH service area. Use of MLHL helps support the Main Line Health System and provides your physician with the highest quality results in the least amount of time. Please Note: LabCorp (also reimbursed at 100%) is available as an alternative service provider for those who may live outside our DVACO service area.

Note 4: There are no Durable Medical Equipment participating providers in the DVACO Network. Please review your benefits enrollment material for more information about the Durable Medical Equipment coverage available to you under the medical plan.

Note 5: Not all anesthesia providers in DVACO non-home facilities are DVACO providers and you may incur a higher member responsibility. For example, Wills Eye has satellite surgery centers outside of their center city Philadelphia main campus that may not use DVACO anesthesia providers. If services are provided by a non-home DVACO anesthesia provider the member will incur higher out of pocket expenses for those services.