Common use of Asthma Clause in Contracts

Asthma. The following services related to asthma are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of asthma and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of asthma • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of asthma • Office visits to an Allergist (allergy specialist) for consultation and routine management of asthma • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider, Pulmonologist, or Allergist • Immunotherapy for allergen sensitization to reduce impact and severity of allergic reactions • Inhaler adjuncts (e.g., spacer) as specified on the formulary and dispensed through our Home Delivery Program • Pulmonary function tests • Asthma education [allergens/triggers, asthma action plan and behavioral modification counseling] • Targeted laboratory tests for the routine management of asthma Please note, if you have complications from asthma and use an urgent care center, emergency department, or have a Hospital stay, services will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits.

Asthma. The following services related to asthma are covered with $0 Out-of-Pocket Out‐of‐Pocket Cost when linked to a primary diagnosis of asthma and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of asthma • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of asthma • Office visits to an Allergist (allergy specialist) for consultation and routine management of asthma • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider, Pulmonologist, or Allergist • Immunotherapy for allergen sensitization to reduce impact and severity of allergic reactions • Inhaler adjuncts (e.g., spacer) as specified on the formulary and dispensed through our Home Delivery Program • Pulmonary function tests • Asthma education [allergens/triggers, asthma action plan and behavioral modification counseling] • Targeted laboratory tests for the routine management of asthma Please note, if you have complications from asthma and use an urgent care center, emergency department, or have a Hospital stay, services will be subject to standard Out-of-Pocket Out‐of‐Pocket Costs as outlined in your Schedule of Benefits.

Asthma. The following services related to asthma are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of asthma and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of asthma • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of asthma • Office visits to an Allergist (allergy specialist) for consultation and routine management of asthma • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider, Pulmonologist, or Allergist • Immunotherapy for allergen sensitization to reduce impact and severity of allergic reactions • Inhaler adjuncts (e.g., spacer) as specified on the formulary and dispensed through our Home Delivery Program • Pulmonary function tests • Asthma education [allergens/triggers, asthma action plan and behavioral modification counseling] • Targeted laboratory tests for the routine management of asthma SAMPLE Please note, if you have complications from asthma and use an urgent care center, emergency department, or have a Hospital stay, services will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits.

Asthma. The following services related to asthma are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of asthma and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of asthma • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of asthma • Office visits to an Allergist (allergy specialist) for consultation and routine management of asthma • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider, Pulmonologist, or Allergist • Immunotherapy for allergen sensitization to reduce impact and severity of allergic reactions • Inhaler adjuncts (e.g., spacer) as specified on the formulary and dispensed through our Home Delivery Program • Pulmonary function tests • Asthma education [allergens/triggers, asthma action plan and behavioral modification counseling] • Targeted laboratory tests for the routine management of asthma • Peak Flow Meter Please note, if you have complications from asthma and use an urgent care center, emergency department, or have a Hospital stay, services will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits.

Asthma. The following services related to asthma are covered with $0 Out-of-Out - of- Pocket Cost when linked to a primary diagnosis of asthma and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of asthma • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of asthma • Office visits to an Allergist (allergy specialist) for consultation and routine management of asthma • Palliative care conversations (chronic ch ronic condition treatment preferences) with Primary Care Provider, Pulmonologist, or Allergist • Immunotherapy for allergen sensitization to reduce impact and severity of allergic reactions • Inhaler adjuncts (e.g., spacer) as specified on the formulary and dispensed d ispensed through our Home Delivery Program • Pulmonary function tests • Asthma education [allergens/allergens/ triggers, asthma action plan and behavioral modification counseling] • Targeted laboratory tests for the routine management of asthma Please note, if you have complications from asthma and use an urgent care center, emergency e mergency department, or have a Hospital stay, services will be subject to standard Out-of-Out - of- Pocket Costs as outlined in your Schedule of BenefitsBenefits .