Common use of Specifically Covered Clause in Contracts

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, Members so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portalportal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from Friday 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxx.xxxxxxxxxx.xxx and use Client ID code LNV20C to complete your registration. For more information on how to sign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxxxx://xxx.xxxxx.xxx/join and use Client ID code 731C73 to complete your registration. For more information on how to sign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, Members so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portalportal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000800-000-0000356- 2219, Monday through Friday, from Friday 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).711.‌‌

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan Insurance Company will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations limitation or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan Insurance Company, Inc. (PHPPIC), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Care Coordination and Case Management are provided by our Care Coordination department Department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our care coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, and establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan Insurance Company members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Insurance Company Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or or‌‌ 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan Insurance Company will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations limitation or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan Insurance Company, Inc. (PHPPIC), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Care Coordination and Case Management are provided by our Care Coordination department Department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our care coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan Insurance Company members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Insurance Company Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or or‌‌‌ 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from form the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, Members so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portalportal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000800-000-0000, 356- 2219 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits‌‌‌ Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php xxx.xxxxxxxxx.xxx/xxx to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go Try the program by going to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/phpxxx.xxxxxxxxxxxxxxxx.xxx/xxx. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxx.xxxxx.xxx/xxxx and use Client ID code: LNV20C to complete your registration. For more information on how to sign up, contact Customer Services at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches management lifestyle coaches’ work with you to help you better manage your chronic disease, such as Asthmadiabetes, Coronary Artery Disease, Diabetes, and/or Hypertensioncoronary artery disease or congestive heart failure. A licensed nurse works with Care is focused on helping you to gain a better understanding identify goals and desires for improving management of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insuredchronic disease. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven (7) days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasedepression, Diabetes, and/or Hypertensionand diabetes. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via textThis benefit has one or more exclusions as specified in the Exclusions Section. Urgent Care Urgent Care is Medically Necessary medical or surgical procedures, video treatments, or audio messaging at Healthcare Services you receive in an Urgent Care Center or in a time and place that is convenient Practitioner’s/Provider’s office for theman unforeseen condition due to illness or injury. Go Urgent conditions are not life-threatening, but require prompt medical attention to xxxxx://xxx.xxxxxxxxx.xxx/php prevent a serious deterioration in your health. • Members are encouraged to access the programcontact their Primary Care Physicians for an appointment, if available, before seeking care from another Practitioner/Provider. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder • We must Prior-Authorize follow-up care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01Out-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0of-000-000-0000 network (or +0-000-000-0000 outside of the USA)5-county area) Practitioner/Provider. The Member will be responsible for charges that we do not Cover. If you believe the condition to be treated is life threatening, you should seek Emergency Healthcare Services as outlined below.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department Department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease , Diabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- management self-management, goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease , Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx/xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000855-000-0000923- 7528, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), portal) Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services visit our website at at‌‌‌ xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan Insurance Company will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan Insurance Company, Inc. (PHPPIC), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Care Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our care coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members Insurance Company Members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Insurance Company Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying Staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertensionhypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or or‌‌‌ 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department Department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- management goalsmanagement, goals and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000855-000-0000923- 7528 , Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease, Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services visit our website at at‌‌‌ xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from form the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, Members so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portalportal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxxxx://xxx.xxxxx.xxx/join and use Client ID code 731C73 to complete your registration. For more information on how to sign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department Department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease , Diabetesdiabetes, and/or Hypertensionhypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- management self-management, goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthmaasthma, Coronary Artery Diseasecoronary artery disease , Diabetesdiabetes, and/or Hypertensionhypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx/xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000800-000-0000356- 2219, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Specifically Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Agreement.‌‌ Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department Department, which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners planners, and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management management, goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx/xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 01-000855-000-0000923- 7528, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. 711.‌‌ Other Programs and Services TalkSpace Messaging therapy offers members age 14 MyChart Members with a Presbyterian Medical Group provider can send electronic messages and older behavioral communicate with their care team, request prescription renewals and schedule office or telephone visits. You can also view medical records, lab and radiology reports, procedures, and test results. For details, visit xxx.xxx.xxx/xxxxxxx. Wellness at Work This online tool helps you create personalized health coaching with licensed behavioral therapists via textimprovement plans and features a powerful Personal Health Assessment (PHA) tool to help identify personal health risks and provide recommendations for improving those risks. To participate, video visit xxx.xxx.xxx and register or audio messaging at a time login onto myPRES. Covered Benefits‌‌ Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health Observation Services This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan Insurance Company will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan Insurance Company, Inc. (PHPPIC), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Care Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our care coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) management health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with Care is focused on helping you to gain a better understanding of your condition, establish self- self-management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members Insurance Company Members have access to PresRN, a nurse advice line available 24 hours a day, 7 days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Insurance Company Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying Staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), . Preventive Health Guidelines (such as Mammography and childhood immunizations) as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxxxxxxx://xxx.xxx.xxx/tools-resources/member/Pages/default.aspx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or or‌‌‌ 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles benefit has one or more away from a permanent residence or exclusions as specified in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA)Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php xxx.xxxxxxxxx.xxx/xxx to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to youxxx.xxxxxxxxxxxxxxxx.xxx/xxx. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), portal) Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at at‌‌‌‌‌‌ xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxxxx://xxx.xxxxx.xxx/join and use Client ID code 731C73 to complete your registration. For more information on how to sign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA). MyChart Members with a Presbyterian Medical Group provider can send electronic messages and communicate with their care team, request prescription renewals and schedule office or telephone visits. You can also view medical records, lab and radiology reports, procedures, and test results. For details, visit xxx.xxx.xxx/xxxxxxx. Wellness at Work This online tool helps you create personalized health improvement plans and features a powerful Personal Health Assessment (PHA) tool to help identify personal health risks and provide recommendations for improving those risks. To participate, visit xxx.xxx.xxx and register or login onto myPRES.‌‌‌ Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services This benefit has one or more exclusions as specified in the Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. disease.‌‌‌ Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portal), ) Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services visit our website at at‌‌‌‌‌‌ xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php xxx.xxxxxxxxx.xxx/xxx to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/phpxxx.xxxxxxxxxxxxxxxx.xxx/xxx. Create Clickotine Clickotine is an account innovative program that uses clinically-driven app technology to help you create and answer stick to a few questions quit plan and overcome nicotine cravings. Go to gain access xxx.xxxxx.xxx/xxxx and use Client ID code 731C73 to the Health Better Services available complete your registration. For more information on how to yousign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA). MyChart Members with a Presbyterian Medical Group provider can send electronic messages and communicate with their care team, request prescription renewals and schedule office or telephone visits. You can also view medical records, lab and radiology reports, procedures, and test results. For details, visit xxx.xxx.xxx/xxxxxxx. Wellness at Work This online tool helps you create personalized health improvement plans and features a powerful Personal Health Assessment (PHA) tool to help identify personal health risks and provide recommendations for improving those risks. To participate, visit xxx.xxx.xxx and register or login onto myPRES.‌‌‌ Covered Benefits Accidental Injury (Trauma), Urgent Care, Emergency Healthcare Services, and Observation Services This benefit has one or more exclusions as specified in the Exclusions Section.

Specifically Covered. This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and Specifically Covered in this Agreement. Specifically Covered means only those Healthcare Benefits that are expressly listed and described in the Benefits Section of the Agreement. In addition, you should refer to the Exclusions Section that lists services that are not Covered under your Healthcare Benefit Plan. All other benefits and services not specifically listed as Covered in the Benefits Section shall be excluded, except for Clinical Preventive Health Services and except as required by state or federal law. There are no annual or lifetime limits on the dollar value of essential health benefits, as defined under the Affordable Care Act. Presbyterian Health Plan will not deny or limit coverage, deny or limit coverage of a claim, or impose additional cost-sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. We determine whether a Healthcare Service or supply is a specifically Covered Benefit. The fact that a Practitioner/Provider has prescribed, ordered, recommended, or approved a Healthcare Service or supply does not guarantee that it is a Covered Benefit even if it is not listed as an Exclusion. Specifically, Covered Benefits are subject to the Limitations, Exclusions, Prior Authorization and other provisions of this Agreement. Medical Necessity This Healthcare Benefit Plan helps pay for healthcare expenses that are Medically Necessary and specifically Covered in this Agreement. Clinical Preventive Health Services do not have to be “Medically Necessary.” ”. Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Health Plan (PHP), to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines we developed consistent with such federal, national, and professional practice guidelines, for the diagnosis or direct care and treatment of a physical, behavioral or mental health condition, illness, injury, or disease. Experimental or Investigational drugs, medicines, treatments, procedures, or devices are not Covered. This does not include Clinical Trials. Please refer to Clinical Trials in the Benefit Section of this Agreement. Care Coordination and Case Management Case Coordination and Case Management are provided by our Care Coordination department which is staffed with registered nurses, social workers, health educators, behavioral health specialists and non-licensed care coordinators that coordinate Covered and non-Covered Healthcare Services for you when you have ongoing or complex diagnoses. The role of the care coordinator/case manager is to support and educate you and other Members, Members so that you are able to make informed healthcare decisions. Our ongoing communication and visits to you and to other Members who may have a chronic illness can trigger prompt intervention and help in the prevention of avoidable episodes of illness. We are committed to the personal service that care management provides to you when you are in need. When you are in the Hospital, our coordinators/case managers can work with the Hospital, their discharge planners and your Practitioners to make sure you get the appropriate level of care and to coordinate your care after you leave the Hospital. Disease Management (DM) health coaches work with you to help you better manage your chronic disease, such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. A licensed nurse works with you to gain a better understanding of your condition, establish self- management goals, and provide coaching to assist you in making lifestyle modifications. At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured. PresRN Presbyterian Health Plan members have access to PresRN, a nurse advice line available 24 hours a day, 7 seven days a week, including holidays. PresRN is a no-cost service for Presbyterian Health Plan Members. Please call at (000) 000-0000 or 0-000-000-0000. Health Management Programs Members have access to resources that support personal health management including online tools, print materials and programs or services to help enhance quality of life in three areas: staying healthy, preventing illness and living with a chronic condition. We help you reach optimum health through educational tools (such as those available on the myPRES Member Portalportal), Preventive Health Guidelines (such as Mammography mammography and childhood immunizations) ), as well as with disease management for conditions such as Asthma, Coronary Artery Disease, Diabetes, and/or Hypertension. If you would like more information about these services services, visit our website at xxx.xxx.xxx. Members can also call our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from Friday 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Other Programs and Services TalkSpace Messaging therapy offers members age 14 and older behavioral health coaching with licensed behavioral therapists via text, video or audio messaging at a time and place that is convenient for them. Go to xxxxx://xxx.xxxxxxxxx.xxx/php to access the program. On to Better Health This interactive software offers an alternative to traditional mental health and substance use disorder care by providing access to tools and resources that are easy to use, confidential and available 24/7. Go to xxxx://xxx.xxxxxxxxxxxxxxxx.xxx/php. Create an account and answer a few questions to gain access to the Health Better Services available to you. Clickotine Clickotine is an innovative program that uses clinically-driven app technology to help you create and stick to a quit plan and overcome nicotine cravings. Go to xxxxx://xxx.xxxxx.xxx/join and use Client ID code 731C73 to complete your registration. For more information on how to sign up, contact Customer Service at (000) 000-0000 or 0-000-000-0000. Assist America You have the protection of Assist America’s global emergency travel assistance services 24 hours a day, 365 days a year. This unique program immediately connects you to services when experiencing a medical emergency while traveling 100 miles or more away from a permanent residence or in another country. First, download the free Assist America Mobile App, then log in with reference number 01-AAPXI-10071. For questions, contact Assist America’s Operations Center at 0-000-000-0000 (or +0-000-000-0000 outside of the USA).