Common use of Podiatric Services Clause in Contracts

Podiatric Services. Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Covered with no wait. Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment when in accordance with the well care schedule established by GHC. Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. • Inpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment for up to sixty (60) days per calendar year. • Outpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for up to sixty (60) visits per calendar year. Not covered. Covered up to sixty (60) days per Member per calendar year. Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment up to $1,000 maximum per Member per calendar year. • Lifetime benefit maximum Covered up to $5,000 per Member. • Individual/group counseling Covered in full when received through the GHC-designated tobacco cessation program. • Approved pharmacy products Covered in full when prescribed as part of the GHC-designated tobacco cessation program and dispensed through the GHC-designated mail order service.

Podiatric Services. Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Covered with no wait. Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment when in accordance with the well care schedule established by GHCGHC . Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. • Inpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment for up to sixty (60) days per calendar year. • Outpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for up to sixty (60) visits per calendar year. Not covered. Covered up to sixty (60) days per Member per calendar year. Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment up to $1,000 maximum per Member per calendar year. • Lifetime benefit maximum Covered up to $5,000 per Member. • Individual/group counseling Covered in full when sessions received through the GHC-designated tobacco cessation programprogram Covered in full. • Approved pharmacy products Covered in full when prescribed as part of the GHC-designated tobacco cessation program and dispensed through the GHC-designated mail order service.

Podiatric Services.  Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable Copayment. •  Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Covered with no wait. Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment when in accordance with the well care schedule established by GHC. Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. •  Inpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment for up to sixty (60) days per calendar year. •  Outpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for up to sixty (60) visits per calendar year. Not covered. Covered up to sixty (60) days per Member per calendar year. Covered subject to the lesser of GHC’s charge or the applicable Copayment. •  Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment up to $1,000 maximum per Member per calendar year. •  Lifetime benefit maximum Covered up to $5,000 per Member. •  Individual/group counseling Covered in full when received through the GHC-designated tobacco cessation program. •  Approved pharmacy products Covered in full when prescribed as part of the GHC-designated tobacco cessation program and dispensed through the GHC-designated mail order service.

Podiatric Services. Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Covered with no wait. Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment when in accordance with the well care schedule established by GHC. Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. • Inpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment for up to sixty (60) days per calendar year. • Outpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for up to sixty (60) visits per calendar year. Not covered. Covered up to sixty (60) days per Member per calendar year. Covered subject to the lesser of GHC’s charge or the applicable CopaymentCopayments. • Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment up to $1,000 maximum per Member per calendar year. • Lifetime benefit maximum Covered up to $5,000 per Member. • Individual/group counseling sessions Covered in full when received through the GHC-designated tobacco cessation programfull. • Approved pharmacy products Covered in full for each thirty (30) day supply or less of a prescription or refill when prescribed as part of the GHC-designated tobacco cessation program by a GHC Provider and dispensed through the GHC-designated mail order serviceobtained at a GHC Facility.