25 Benefits Vision Services For Members to the End of the Month in Which They Turn Age 19 Note: To get the In-Network benefit, you must use an In-Network vision Provider. If you need help finding an In-Network vision Provider, please call us at the number on the back of your ID card. • Routine Eye Exam Available once per Member every Benefit Period $0 Copayment Deductible Does not Apply $0 Copayment up to the Plan’s Maximum Allowed Amount Vision Services For Members Age 19 and Older Note: To get the In-Network benefit, you must use an In-Network vision Provider. If you need help finding an In-Network vision Provider, please call us at the number on the back of your ID card. • Routine Eye Exam Available once per Member every Benefit Period $0 Copayment Deductible Does not Apply Reimbursed up to $42 Vision Services (For medical and surgical treatment of injuries and/or diseases of the eye) Certain vision screenings required by Federal law are covered under the "Preventive Care" benefit. Benefits are based on the setting in which Covered Services are received. Human Organ and Tissue Transplant (Bone Marrow / Stem Cell), Cellular and Gene Therapy Services Please call our Transplant Department as soon as you think you may need a Covered Procedure to talk about your benefit options. To get the Participating Level of benefits under your Plan, you must get certain Covered Procedures from an Approved Participating Provider. Even if a Hospital is an Participating Provider for other services, it may not be an Approved Participating Provider for certain Covered Procedures. Please see the “What’s Covered” section for further details. The requirements described below do not apply to the following: • Cornea transplants, which are covered as any other surgery; and • Any Covered Services related to a Covered Procedure that you get before or after the Benefit Period.