Common use of Preventive Health Services for Women Clause in Contracts

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • · Well-woman visits to include adult and female-specific screenings and preventive benefits • benefits. · Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • · Cervical cancer screening for women ages 21 to 65 years old • old. · Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • infection. · Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • · Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • · Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problemsdepression. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • · Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) · HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) · HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • · HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • ACIP). · Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancerpregnancy. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • · Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • · Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/.

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. diabetes.‌ • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast breast-feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening Cancer Screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea Gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status status. • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services We will provide Coverage for Women include all Clinical Preventive Health Services discussed in this Benefits Section without any Cost Sharing at an age and those specific frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to Womenwomen, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all womendepression. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. older.‌‌‌ • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status status. • Human Papillomavirus (HPV) HPV DNA Testtest: High high-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) STIs counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. Coverage.‌‌‌ You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status status. • Human Papillomavirus (HPV) HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) STIs counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies Therapies‌‌‌ This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services We will provide Coverage for Women include all Clinical Preventive Health Services discussed in this Benefits Section without any Cost Sharing at an age and those specific frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to Womenwomen, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all womendepression. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. older.‌ • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) STIs counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. Coverage.‌‌ You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. older.‌ • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits benefits. • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old old. • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection infection. • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status status. • Human Papillomavirus (HPV) HPV DNA Testtest: High high-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and overpregnancy. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) STIs counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section. Acupuncture‌‌‌ Acupuncture is treatment by means of inserting needles into the body to reduce pain or to induce anesthesia. It may also be used for other diagnoses as determined appropriate by your Practitioner/Provider. It is recommended that Acupuncture be part of a coordinated plan of care approved by your Practitioner/Provider. Acupuncture must be performed by an appropriately licensed and credentialed healthcare provider (i.e. a doctor of Oriental Medicine). Acupuncture services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Chiropractic Services Chiropractic services are available for specific medical conditions and are not available for maintenance therapy such as routine adjustments. Chiropractic services are subject to the following: • The Practitioner/Provider determines in advance that Chiropractic treatment can be expected to result in Significant Improvement in your condition within a period of two months. • Chiropractic treatment is specifically limited to treatment by means of manual manipulation; i.e., by use of hands, and other methods of treatment approved by us including, but not limited to, ultrasound therapy. • Subluxation must be documented by Chiropractic examination and documented in the chiropractic record. We do not require Radiologic (X-ray) demonstration of Subluxation for Chiropractic treatment. Chiropractic services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years years‌ for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • Preeclampsia screenings in pregnant women throughout pregnancy ACIP). • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Preeclampsia screenings in pregnant women throughout pregnancy • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast breast-feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one 1 year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy pregnancy‌‌ • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services We will provide Coverage for Women include all Clinical Preventive Health Services discussed in this Benefits Section without any Cost Sharing at an age and those specific frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to Womenwomen, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes but is not limited to: •  Well-woman visits to include adult and female-specific screenings and preventive benefits • benefits.  Breast Cancer: Medication Use to Reduce Risk  Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication  Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. •  Cervical cancer screening for women ages 21 to 65 years old • old.  Chlamydia and gonorrhea screenings for sexually active women ages 24 age 25 years or younger and for older women at increased risk for infection • infection.  Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. •  Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. •  Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problemsdepression. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. •  Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV)  HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV)  Cervical cancer screening every three years for women 21-65 years of age who are at average risk.  HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or olderresults. •  HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • ACIP).  Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage pregnancy.  Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication for low-dose screening mammograms to determine the presence of breast cancerpregnant persons at high risk for preeclampsia. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. •  Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. •  Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women Urinary incontinence screening. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to Women: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf 00143765.pdf. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administeredadminstered. • Counseling for HIV, sexually transmitted diseases and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Preeclampsia screenings in pregnant women throughout pregnancy • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast breast-feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings Gonorrhea screening for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases infections and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services We will provide Coverage for Women include all Clinical Preventive Health Services discussed in this Benefits Section without any Cost Sharing at an age and those specific frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to Womenwomen, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • benefits. Breast Cancer: Medication Use to Reduce Risk Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • old. Chlamydia and gonorrhea screenings for sexually active women ages 24 age 25 years or younger and for older women at increased risk for infection • infection. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problemsdepression. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) Cervical cancer screening every three years for women 21-65 years of age who are at average risk. HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or olderresults. • HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • ACIP). Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage pregnancy. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication for low-dose screening mammograms to determine the presence of breast cancerpregnant persons at high risk for preeclampsia. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for womenUrinary incontinence screening. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive Services We will provide Coverage for Women include all Clinical Preventive Health Services discussed in this Benefits Section without any Cost Sharing at an age and those specific frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to Womenwomen, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes but is not limited to: • · Well-woman visits to include adult and female-specific screenings and preventive benefits • benefits. · Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • · Cervical cancer screening for women ages 21 to 65 years old • old. · Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • infection. · Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharingCost Sharing, utilization reviewUtilization Review, prior authorizationPrior Authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827. o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • · Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • · Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problemsdepression. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • · Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) · HIV screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) · HPV DNA Testtest: High High-risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • · HPV Vaccine vaccine coverage for the Human Papillomavirus HPV as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • ACIP). · Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancerpregnancy. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • · Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • · Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • · Well-woman visits to include adult and female-specific screenings and preventive benefits • · Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • · Cervical cancer screening for women ages 21 to 65 years old • · Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • · Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827 o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • · Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • · Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • · Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • · Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • · Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. • · HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ • ACIP). · Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • · Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • · Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings Gonorrhea screening for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screeningdepression. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding counseling. • Sexually Transmitted Infections (STI) STI counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/search/?q=preventive. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.

Preventive Health Services for Women. Preventive With respect to women, evidence-informed preventive care and screenings for the comprehensive guidelines supported by the Health Resources and Services for Women include all Clinical Preventive Health Services discussed in this Benefits Section and those specific to WomenAdministration (HRSA). Key preventive care includes but is not limited to: • Well-woman visits to include adult and female-specific screenings and preventive benefits • Breastfeeding comprehensive support, supplies and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women are covered for one year after delivery. • Cervical cancer screening for women ages 21 to 65 years old • Chlamydia and gonorrhea screenings for sexually active women ages age 24 years or younger and for older women at increased risk for infection • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs. Coverage for contraception is not subject to cost-sharing, utilization review, prior authorization, step-therapy requirements, or any other restrictions or delays on coverage. o Methods of preferred generic oral contraceptives, injectable contraceptives or contraceptive devices. For a complete list of these preferred products, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/@phs/@php/documents/phscontent/pel _00143765.pdf xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxx.xxx/Search.aspx?siteCode=0045707827 o Coverage of a six-month supply of contraceptives at one time, provided that the contraceptives are prescribed and self-administered. • Counseling and screening for HIV, sexually transmitted diseases STIs and domestic violence and abuse. • Counseling interventions for pregnant and postpartum persons who are at an increased risk of perinatal depression • Cytological Screening (PAP Smear) and Human Papillomavirus (HPV) screening to determine the presence of precancerous or cancerous conditions and other health problems. Coverage includes persons 18 years of age or older and for women who are at risk of cancer or other health conditions that can be identified through Cytological Screening. • Domestic and interpersonal violence screening and counseling for all women. • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. • Human Immunodeficiency Virus (HIV) screening and counseling for sexually active and pregnant women. For pregnant women, the screening will be covered at any point of the pregnancy, even those who present in labor with an unknown status • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three 3 years for women with normal cytology results who are 30 or older. • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).‌ ACIP). • Preeclampsia screenings in pregnant women throughout pregnancy • Mammography Coverage for low-dose screening mammograms to determine the presence of breast cancer. Coverage includes but is not limited to, one baseline mammogram to persons age 35 through 39, one mammogram biennially to persons age 40-49 and one mammogram annually to persons age 50 and over. • Screenings and Counseling for pregnant women including screenings for anemia, bacteriuria, Hepatitis B, and Rh incompatibility and breast feeding breastfeeding counseling. • Sexually Transmitted Infections (STI) counseling for sexually active women. • Sterilization services for women only. Other services, performed during the procedure, are subject to deductible and coinsurance as outlined in your Summary of Benefits and Coverage. • Well–woman visits to obtain recommended preventive services for women. You can obtain additional information about Women’s Preventive Services recommendations and guidelines on the XxxxxxXxxx.xxx website at xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care- women/. xxxxx://xxx.xxxxxxxxxx.xxx/preventive-care-women/. Complementary Therapies This benefit has one or more exclusions as specified in the Exclusions Section.