Common use of Telemedicine Clause in Contracts

Telemedicine. The practice of telemedicine, by a duly licensed Provider, by means of audio, video or data communications (to include secured electronic mail) is a covered benefit. The use of standard telephone, facsimile transmissions, unsecured electronic mail, or a combination thereof does not constitute telemedicine service and is not a covered benefit. The use of telemedicine may substitute for a face-to-face “hands on” encounter for consultation. To be eligible for payment, interactive audio and video telecommunications must be used, permitting real-time communications between the distant Provider and the Member. As a condition of payment, the Member must be present and participating. The amount of payment for the professional service provided via telemedicine by the Provider at the distant site is based on the negotiated rate or current MAC for the service provided. TRANSPLANT ORGAN/TISSUE/BONE MARROW Alliant’s transplant network facilities are independent of our Preferred Provider network. Transplants that are provided at a non- Alliant Transplant Network Facility, even if the non-Alliant Transplant Network Facility is a participating provider, are not covered. Covered Services include certain services and supplies not otherwise excluded in this Certificate and rendered in association with a covered transplant, including pre-transplant procedures such as organ harvesting (donor costs), post-operative care (including anti-rejection drug treatment, if Prescription Drugs are covered under the Contract) and transplant related chemotherapy for cancer limited as follows. A transplant means a procedure or series of procedures by which an organ or tissue is either: • Removed from the body of one person (called a donor) and implanted in the body of another person (called a recipient); or • Removed from and replaced in the same person’s body (called a self-donor).

Telemedicine. The practice of telemedicineTelemedicine, by a duly licensed Provider, by means of audio, video or data communications (to include secured electronic mail) is a covered benefit. The use of standard telephoneTelephone, facsimile transmissions, unsecured electronic mail, or a combination thereof does not constitute telemedicine service and is not a covered benefit. The use of telemedicine Telemedicine may substitute for a face-to-face “hands on” encounter for consultation. To be eligible for payment, interactive audio and video telecommunications must be used, permitting real-time communications between the distant Provider and the Member. As a condition of payment, the Member must be present and participating. The amount of payment for the professional service provided via telemedicine by the Provider at the distant site is based on the negotiated rate or current MAC for the service provided. TRANSPLANT ORGAN/TISSUE/BONE MARROW Alliant’s transplant network facilities are independent of our Preferred Provider network. Transplants that are provided at a non- Alliant Transplant Network Facility, even if the non-Alliant Transplant Network Facility is a participating provider, are not covered. Covered Services include certain services and supplies not otherwise excluded in this Certificate and rendered in association with a covered transplant, including pre-transplant procedures such as organ harvesting (donor costs), post-operative care (including anti-rejection drug treatment, if Prescription Drugs are covered under the Contract) and transplant related chemotherapy for cancer limited as follows. A transplant means a procedure or series of procedures by which an organ or tissue is either: • Removed from the body of one person (called a donor) and implanted in the body of another person (called a recipient); or • Removed from and replaced in the same person’s body (called a self-donor).

Telemedicine. The practice of telemedicine, by a duly licensed Provider, by means of audio, video or data communications (to include secured electronic mail) is a covered benefit. The use of standard telephone, facsimile transmissions, unsecured electronic mail, or a combination thereof does not constitute telemedicine service and is not a covered benefit. The use of telemedicine may substitute for a face-to-face “hands on” encounter for consultation. To be eligible for payment, interactive audio and video telecommunications must be used, permitting real-time communications between the distant Provider and the Member. As a condition of payment, the Member must be present and participating. The amount of payment for the professional service provided via telemedicine by the Provider at the distant site is based on the negotiated rate or current MAC for the service provided. TRANSPLANT ORGAN/TISSUE/BONE MARROW Alliant’s transplant network facilities are independent of our Preferred Provider network. Transplants that are provided at a non- Alliant Transplant Network Facility, even if the non-Alliant Transplant Network Facility is a participating provider, are not covered. Covered Services include certain services and supplies not otherwise excluded in this Certificate and rendered in association with a covered transplant, including pre-transplant procedures such as organ harvesting (donor costs), post-operative care (including anti-rejection drug treatment, if Prescription Drugs are covered under the Contract) and transplant related chemotherapy for cancer limited as follows. A transplant means a procedure or series of procedures by which an organ or tissue is either: • Removed from the body of one person (called a donor) and implanted in the body of another person (called a recipient); or • Removed from and replaced in the same person’s body (called a self-donor). A covered transplant means a medically appropriate transplant. Human organ or tissue transplants for cornea, lung, heart or heart/lung, liver, kidney, pancreas or kidney and pancreas when transplanted together in the same operative session. • Autologous (self-donor) bone marrow transplants with high-dose chemotherapy is considered eligible for coverage on a prior approval basis, but only if required in the treatment of: o Non-Hodgkin’s lymphoma, intermediate or high-grade Stage III or IVB; o Hodgkin’s disease (lymphoma), Stages IIIA, IIIB, IVA, or IVB; o Neuroblastoma, Stage III or Stage IV; o Acute lymphocytic or nonlymphocytic leukemia patients in first or subsequent remission, who are at high risk for relapse and who do not have HLA-compatible donor available for allogenic bone marrow support; o Germ cell tumors (e.g., testicular, mediastinal, retroperitoneal, ovarian) that are refractory to standard dose chemotherapy, with FDA-approved platinum compounds; o Metastatic breast cancer that (a) has not been previously treated with systemic therapy, (b) is currently responsive to primary systemic therapy, or (c) has relapsed following response to first-line treatment; • Newly diagnosed or responsive multiple myeloma, previously untreated disease, those in a complete or partial remission, or those in a responsive relapse Homogenic/allogenic (other donor) or syngeneic hematopoietic stem cells whether harvested from bone marrow peripheral blood or from any other source, but only if required in the treatment of: o Aplastic anemia; o Acute leukemia; o Severe combined immunodeficiency exclusive of acquired immune deficiency syndrome (AIDS); o Infantile malignant osteoporosis; o Chronic myelogenous leukemia; o Lymphoma (Xxxxxxx-Xxxxxxx syndrome); o Lysosomal storage disorder; o Myelodysplastic syndrome. Donor Costs means all costs, direct and indirect (including program administration costs), incurred in connection with: • Medical services required to remove the organ or tissue from either the donor’s or the self- donor’s body; • Preserving it; and • Transporting it to the site where the transplant is performed. In treatment of cancer, the term transplant includes any chemotherapy and related courses of treatment which the transplant supports. For purposes of this benefit, the term transplant does not include transplant of blood or blood derivatives (except hematopoietic stem cells) which will be considered as non-transplant related under the terms of the Contract.