Res 1988-077 - Laserfiche WebLink

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E.2., 4., 7., and 8. of Benefits, and F. of General Exclusions.) a. Services and supplies provided by or under the direction of a Participating Primary Care Physician in the Physician's office including the follo~ing preventative medical care: voluntary family planning, ~ell child care from birth, periodic health evaluations, immunizations, ear examinations to determine the need for hearing correction, and except for Maternity, in which copayment will only be charged for the first visit. b. Authorized services and supplies ordered by and provided by or under the direction of a Participating Specialist Physician in the physician's office. c. Vision care (except for the diagnosis and treatment of diseases of or inJury to the eyes) provided by a Participating Specialist Physician in the physician's office when authorized by Health Plan. d. Authorized physician services and other surgical and medical care provided by or under the direction of that Participating Physician in a Participating Hospital, Skilled Nursing Facility or other Approved Health Care Facility or Program. e. Infertility Services, unless specifically excluded in this section under r., and only when authorized in writing in advance by Health Plan. f. Authorized Allergy Services 2. Hospital and related services and services of an Alcohol Dependency Treatment Facility which is a Participating Provider, when authorized by a Participating Primary Care Physician or Health Plan's Psychiatric Primary Provider (except for the Hospital Services identified in this section under E.4., 5., 7., and 8. of Benefits and r. of General Exclusions.) a. Inpatient Services (1) Room and Board Unlimited confinement for that period of time deemed Medically Necessary by a Participating Primary Care Physician SB-Al -)- $5 $5 All charges over $35 per member per Calendar Year NONE NONE NONE NONE