Common use of Direct Access Specialist Benefits Clause in Contracts

Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of covered Infertility services. 1. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam every 24 Months period. 2. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam every 24 Months period. 3. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam every 24 Months period. 4. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1exam every 24 Months period.

Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Open Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of covered Infertility servicesbenefits. • Direct Access to Dermatologists. Benefits are provided for Members for dermatological services performed by a Participating Dermatologist. 1. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 one exam every 24 Months 12-month period. 2. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 one exam every 24 Months 24-month period. 3. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 one exam every 24 Months 36-month period. 4. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1exam one exam every 24 Months 24-month period. 5. Preventive eye examinations by a physician, optometrist, or other participating provider to determine the need for correction, for Members through age seventeen (17) are covered.

Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of covered Infertility services. 1. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam exam(s) every 24 Months 12-month period. 2. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam exam(s) every 24 Months 24-month period. 3. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam exam(s) every 24 Months 36-month period. 4. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1exam 1 exam(s) every 24 Months 24-month period.