Common use of Preventive Care Services Clause in Contracts

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening(xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), mammography and prevention issued in including screening colonoscopy or around November 2009 are not considered to be currentsigmoidoscopy. • Immunizations that have in effect a recommendation from for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and PreventionPrevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen Administration (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessmentHRSA)(xxx.xxxx.xxx). Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one include: • Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Physician, if you have any questions or need assistance locating a provider for these services. • One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-cost effective pump. We will determine the following: •  Which pump is the most cost-cost effective. •  Whether the pump should be purchased or rented (and the duration of any rental)rented. •  Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening Contraceptive devices, including digital rectal exams the insertion or removal of, and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between any Medically Necessary consultations, examinations, or procedures associated with, the ages use of 40 intrauterine devices, diaphragms, injectable contraceptives, and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancerimplanted hormonal contraceptives. Benefits include voluntary female sterilization and associated anesthesia. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; Tobacco use screening for all adults and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations cessation interventions for lowering risks identified in the completed health risk assessmenttobacco users. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration as well as contraceptives that are Medically Necessary and FDA approved. • Prostate cancer screening Contraceptive devices, including digital rectal exams the insertion or removal of, and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between any Medically Necessary consultations, examinations, or procedures associated with, the ages use of 40 intrauterine devices, diaphragms, injectable contraceptives, and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancerimplanted hormonal contraceptives. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a include voluntary basis; female sterilization and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessmentassociated anesthesia. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental. Benefits include: • Baseline breast cancer screening mammography for women over age 35 and under age 40. • Annual breast cancer screening mammography for women age 40 and older. Breast cancer screening mammography is a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer. Breast cancer screenings that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force are described under Preventive Care Services. For further information regarding a preventive health services listing, please refer to the U.S. Preventive Services Task Force website at xxxx://xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. SAMPLE • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening(xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), mammography and prevention issued in including screening colonoscopy or around November 2009 are not considered to be currentsigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and PreventionPrevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA)(xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means Physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA) (xxx.xxxx.xxx). • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one include: ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Provider, if you have any questions or need assistance locating a provider for these services. ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx xxx.xxxxx.xxx or the telephone number on your ID card. 🢒 If more than one breast pump can meet your needs, Benefits are available only for the most cost-cost effective pump. We will determine the following: • − Which pump is the most cost-cost effective. • − Whether the pump should be purchased or rented (and the duration of any rental). • − Timing of purchase or rental. SAMPLE • Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. • Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital-based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital- based weight loss programs offered by and held at licensed hospitals qualify for reimbursement. ▪ To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: UnitedHealthcare PO Box 740800 Atlanta, GA 30374-0800 ▪ For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: •  Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task ForceForce (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. Note that recommendations  Immunizations for: (i) routine childhood immunizations for residents of the United States Preventive Services Task Force regarding breast cancer screening, mammography commonwealth; and prevention issued in or around November 2009 (ii) immunizations for residents of the commonwealth who are not considered to be current. • Immunizations 19 years of age and older that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and PreventionPrevention (CDC)(xxx.xxx.xxx). • Sample  With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA)(xxx.xxxx.xxx), including screening for lead poisoning. • For purposes of this Benefit, "preventive care services" means Physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical examination, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six.  With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA) (xxx.xxxx.xxx). • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment.  Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one include: ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Provider, if you have any questions or need assistance locating a provider for these services. ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx xxx.xxxxx.xxx or the telephone number on your ID card.  If more than one breast pump can meet your needs, Benefits are available only for the most cost-cost effective pump. We will determine the following: •  Which pump is the most cost-cost effective. •  Whether the pump should be purchased or rented (and the duration of any rental). •  Timing of purchase or rental. Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital- based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital-based weight loss programs offered by and held at licensed hospitals qualify for reimbursement. To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: UnitedHealthCare PO Box 740800 Atlanta, GA 30374-0800 For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening(xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), mammography and prevention issued in including screening colonoscopy or around November 2009 are not considered to be currentsigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and PreventionPrevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA)(xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means Physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration (HRSA) (xxx.xxxx.xxx). • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment.  Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one include: ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Provider, if you have any questions or need assistance locating a provider for these services. ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx xxx.xxxxx.xxx or the telephone number on your ID card.  If more than one breast pump can meet your needs, Benefits are available only for the most cost-cost effective pump. We will determine the following: • − Which pump is the most cost-cost effective. • − Whether the pump should be purchased or rented (and the duration of any rental). • − Timing of purchase or rental. Sample • Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. • Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital-based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital- based weight loss programs offered by and held at licensed hospitals qualify for reimbursement.  To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: UnitedHealthcare PO Box 740800 Atlanta, GA 30374-0800  For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.