Hearing aid services. This benefit covers one medically necessary hearing aid, per ear, every three years when ordered by or purchased as a result of a written recommendation from an otolaryngologist or a state-certified audiologist. The member is responsible for 50% coinsurance. Member coinsurance is included in the annual out of pocket max. Covered services include:  Audiological evaluations to: – measure the extent of hearing loss; and – determine the most appropriate make and model of hearing aid. These evaluations will be covered under the plan benefits for office visits to doctors.  Hearing aids (monaural or binaural) including: – ear mold(s), the hearing aid instrument; and – batteries, cords and other ancillary equipment.  Visits for fitting, counseling, adjustments and repairs for the covered hearing aid. The benefit does not include the following:

Hearing aid services. Your Plan provides coverage for hearing aid services, subject to the conditions and limitations listed below. The hearing aid services Benefit provides a combined maximum allowance every 36 months as shown on the Summary of Benefits towards covered hearing aids and services as specified below. You are not required to use a Participating Provider to obtain these services as Blue Shield does not maintain a network of contracted providers for these services. You may obtain these services from any provider of your choosing and submit a claim to Blue Shield for reimbursement for Covered Services up to the combined maximum allowance. For information on submitting a claim, see the Claims section.

Hearing aid services. Blue Shield hearing aid services benefits are administered by EPIC Hearing Healthcare (EPIC). EPIC is a hearing care service plan which contracts with Blue Shield to administer delivery of hearing aid ex- aminations, instruments and services related to the hearing aid instruments covered under this hearing aid services benefit. The Summary of Benefits sets forth the Mem- ber’s share-of-cost for covered services under the benefit plan. This benefit is designed for Members to obtain covered services from par- ticipating providers within the EPIC network. EPIC Participating Providers may be located online at xxxxxxxxxxxx.xxx/XxxxxxxXxxx or by contacting EPIC directly at 0-000-000-0000, TTY: 711 Monday through Friday, 6:00 a.m. to 6:00 p.m. PT. If you choose to use EPIC Non- Participating Providers, those services will not be covered. Hearing aid benefits every year include: a) routine hearing aid exam – one hearing ex- amination. Evaluation/screening includes a pure tone audiometry (threshold) test also referred to as an air conduction test for the appropriate type of hearing aid. b) hearing aid instruments – up to two hearing aids. Choice of hearing aids include: i. Private-labeled Silver (mid-level) tech- nology. ii. Private-labeled Gold (premium level) technology. c) hearing aid services - provided when hear- ing aid devices are obtained from partici- pating providers as follows: i. one hearing aid consultation. ii. two-year supply of batteries per hear- ing aid. iii. three-year extended warranty which includes coverage for loss, damage and servicing. Forty-five day hearing aid device evaluation period subject to a restocking fee of $175 (if applicable) which is the Member’s responsibility for returned hearing aids. iv. Silver technology level hearing aids include: • one behind-the-ear hearing aid (non- ear mold model) delivered directly to your home. • up to three virtual follow-up visits by a participating provider for hearing aid fitting, consultation, device check, and adjustment for no addi- tional cost. v. Gold technology level hearing aids in- clude: • one hearing aid delivered in-person by a participating provider. • up to three in-person follow-up visits for hearing aid fitting, consultation, device check, and adjustment for no additional cost. • standard ear molds & impressions. 00.Xxxxxx: Blue Shield’s vision benefits are admin- istered by Vision Service Plan (VSP), a vision care service plan licensed by the California De- partment of Managed He...

Hearing aid services. A. The Contractor shall perform prior authorization reviews for hearing aid dispensing, purchase, rental and replacement and for repairs exceeding one hundred dollars ($100). B. The policy for these services is in 8.324.6 NMAC. A vendor initiates the review with an HSD designated prior authorization form and other supporting documents. Documentation that the attending physician ordered or prescribed the requested equipment or supply that is specifically designated as a purchase or rental and justification of the medical necessity is required. Each request usually contains more than one type of service. Each request “package” constitutes a single review. The focus for the review is a determination of the medical necessity of the requested services and the amounts.

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Hearing Aids Any active employee who is insured under any one of the 9 District sponsored medical plans may request reimbursement for the costs of 10 hearing aids. The maximum amount of reimbursement shall not exceed one 11 thousand dollars ($1,000) within any three (3) year period. The cost of 12 hardware, fitting tests, and other tests related to the hearing aids purchased 13 shall be included for reimbursement purposes. 14
Hearing Services Hearing Exams and Tests Hearing Aids
REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and
Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.
Telemedicine Services This plan covers clinically appropriate telemedicine services when the service is provided via remote access through an on-line service or other interactive audio and video telecommunications system in accordance with R.I. General Law § 27-81-1. Clinically appropriate telemedicine services may be obtained from a network or non- network provider, and from our designated telemedicine service provider. When you seek telemedicine services from our designated telemedicine service provider, the amount you pay is listed in the Summary of Medical Benefits. When you receive a covered healthcare service from a network or non-network provider via remote access, the amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits. For information about telemedicine services, our designated telemedicine service provider, and how to access telemedicine services, please visit our website or contact our Customer Service Department.
Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.
Our Services As insurance intermediaries we generally act as the agent of our client. We are subject to the law of agency, which imposes various duties on us. However, in certain circumstances we may act for and owe duties of care to other parties, including the insurer. We will advise you when these circumstances occur, so you will be aware of any possible conflict of interest. We offer a wide range of products and services which may include: • Offering you a single or range of products from which to choose a product that suits your insurance needs; • Advising you on your insurance needs; • Arranging suitable insurance cover with insurers to meet your requirements; • Helping you with any subsequent changes to your insurance you have to make; • Providing all reasonable assistance with any claim you make. In some cases, we act for insurers under a delegated authority agreement and can enter into insurance policies, issue policy documentation and/or handle or settle claims on their behalf. Where we act on behalf of the insurer and not you, we will notify you accordingly and in relation to claims we will advise you of this fact when you notify us of a claim. Notwithstanding this, we endeavour to always act in your best interest. As intermediaries, we offer a wide range of insurance products and have access to many leading insurance companies and the Lloyd’s market. Depending on the type of cover you require and where we have provided advice based on a personal recommendation, we will offer you a policy from either: • a single insurer; • a limited range of insurers; or • a fair analysis that is representative of the insurance market. We will advise you separately as to which of these apply before we arrange your policy and where we have not undertaken a fair analysis of the market, we will provide you with a list of insurers considered. Jensten Retail Consumer Client TOBA Version 1.0 Nov 2021 Policies taken out, amended, or renewed through our online service will be on a non-advised basis. This means sufficient information will be provided for you to make an informed decision about any product purchased online and you should therefore ensure that any policy provides the cover you require and is suitable for your needs. For Motor Vehicle insurance we require customers to pay an additional charge for our claims service – Coversure Claimsline (details are provided in a separate document). This is a “one-stop” service that enables us to assist you with any claim you may incur. The cost of the Coversure Claimsline services will be included in the price quoted to you for the Motor Vehicle insurance and shown separately in your documentation. By purchasing motor insurance from us, you authorise Coversure and its agents to take all necessary actions to handle your claim including dealing with your insurers, third parties and their insurers and other service suppliers on your behalf. For all other policies, including optional additional products and premium finance (if relevant), before the insurance contract is concluded and after we have assessed your demands & needs, we will provide you with advice and make a personal recommendation. This will include sufficient information to enable you to make an informed decision about the policy that we have recommended, together with a quotation which will itemise any fees that are payable in addition to the premium. This documentation will also include a statement of your demands and needs. You should read this carefully as it will explain reasons for making the recommendation we have made.
Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.
Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.
Routing for Operator Services and Directory Assistance Traffic For a Verizon Telecommunications Service dial tone line purchased by CBB for resale pursuant to the Resale Attachment, upon request by CBB, Verizon will establish an arrangement that will permit CBB to route the CBB Customer’s calls for operator and directory assistance services to a provider of operator and directory assistance services selected by CBB. Verizon will provide this routing arrangement in accordance with, but only to the extent required by, Applicable Law. Verizon will provide this routing arrangement pursuant to an appropriate written request submitted by CBB and a mutually agreed-upon schedule. This routing arrangement will be implemented at CBB's expense, with charges determined on an individual case basis. In addition to charges for initially establishing the routing arrangement, CBB will be responsible for ongoing monthly and/or usage charges for the routing arrangement. CBB shall arrange, at its own expense, the trunking and other facilities required to transport traffic to CBB’s selected provider of operator and directory assistance services.

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