Common use of Diabetes Clause in Contracts

Diabetes. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist (diabetes specialist) for consultation and management of diabetes • Office visits to a Podiatrist (foot specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 150 every 30 days or 450 every 90 days at $0 Out-of-Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care center, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps, continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME); they are not covered under the CISP benefit and they are subject to applicable Plan cost-sharing terms.

Diabetes. The following services related to diabetes are covered with $0 Out-of-Pocket Out‐of‐Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist (diabetes specialist) for consultation and management of diabetes • Office visits to a Podiatrist (foot specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 150 every 30 days or 450 every 90 days at $0 Out-of-Pocket Out‐of‐Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care center, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Out‐of‐Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps, continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME); they are not covered under the CISP benefit and they are subject to applicable Plan cost-sharing cost‐sharing terms.

Diabetes. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist (diabetes specialist) for consultation and management of diabetes • Office visits to a Podiatrist (foot specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 150 every 30 days or 450 every 90 days at $0 Out-of-Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care center, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps, continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME); they are not covered under the CISP benefit and they are subject to applicable Plan cost-sharing terms.. SAMPLE

Diabetes. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): SAMPLE • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist (diabetes specialist) for consultation and management of diabetes • Office visits to a Podiatrist (foot specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 150 every 30 days or 450 every 90 days at $0 Out-of-Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care center, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps, continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME); they are not covered under the CISP benefit and they are subject to applicable Plan cost-sharing terms.

Diabetes. The following services related to diabetes are covered with $0 Out-of-Out - of - Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist Endocrinolog ist (diabetes specialist) for consultation and management of diabetes • Office visits to t o a Podiatrist Podiatr ist (foot foo t specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Optometrist/ Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery ProgramProgram : up to 150 every 30 days or 450 every 90 days at $0 Out-of-Out - of- Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care centercenter , have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Out - of- Pocket Costs as outlined in your Schedule of BenefitsBenefits . Insulin pumpspumps , continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME)) ; they are not covered under the CISP benefit and they are subject to applicable Plan cost-cost - sharing termsterms .