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<br />AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY RIDER <br />FOR USE ONLY WITH CENTRAL TEXAS HEALTH PLAN <br />GROUP MASTER CONTRACTS /ENROLLEES CERTIFICATE OF COVERAGE <br /> <br />In consideration of <br />this Rider together <br />Benefits, Terms and <br />Contract/Certificates <br /> <br />timely payment of premiums, it is agreed that the benefits of <br />with the terms and conditions hereof shall be added to the <br />Conditions of the Central Texas Health Plan Group Master <br />in conjunction with this Rider as issued. <br /> <br />PART I - DEFINITIONS <br /> <br />Benefits for audiology and speech-language pathology provided through this Rider are <br />subject to the provisions to the Group Master Contract/Certificate to which this <br />Rider is a part. <br /> <br />Audiologist - A person who has received a master's or doctorate degree in audiology <br />from an accredited college or university and is certified by the American Speech- <br />Language and Hearing Association. <br /> <br />Speech-Language Pathologist A person who has received a master's or doctorate <br />degree in speech-language pathology from an accredited college or university and is <br />certified by the American Speech-Language and Hearing Association to restore speech <br />loss or correct a speech impairment. <br /> <br />PART II - BENEFITS <br /> <br />For the purpose of this Rider, benefits to measure hearing for the purpose of <br />determining the presence or extent of a hearing loss and to provide aural <br />rehabilitation services will only be provided by an audiologist if such services are <br />recommended by a participating CTHP physician and approved in advance by CTHP. <br />Benefits to evaluate speech and language and to provide habilitation and <br />rehabilitative services to restore speech or language loss or to correct a speech or <br />language impairment will only be provided by a speech-language pathologist if such <br />services are recommended by a participating CTHP physician and approved in advance <br />by CTHP. <br /> <br />PART III - OTHER PROVISIONS <br /> <br />A. <br /> <br />Benefits cover the Subscriber/Employee only enrolled under a self only <br />membership. Benefits cover the Subscriber/Employee and eligible dependents <br />(spouse and dependent children) as identified under family membership. <br /> <br />B. <br /> <br />Benefits provide no conversion privileges or benefit continuity for Subscribers <br />or eligible dependents when covered persons are no longer entitled to group <br />benefits set forth under the Group Master Contract to which this Rider is a <br />part. <br /> <br />CENTRAL TEXAS HRALm PLAN <br /> <br />BY : Ì"J 'O¥'-D I ~ <br />Diana Tchida <br />Chief Executive Officer <br /> <br />ASLP-2 00/86} <br />