61 Preventive Care for Chronic Conditions (per IRS guidelines) Members with certain chronic health conditions may be able to receive preventive care for those conditions prior to meeting their Deductible, when services are provided by an In-Network Provider. These benefits are available if the care qualifies under guidelines provided by the Treasury Department, Internal Revenue Service (IRS), and Department of Health and Human Services (HHS) (referred to as “the agencies”). This includes care for the following chronic conditions: Preventive Care For Members Diagnosed With Blood pressure monitor Hypertension Retinopathy screening Diabetes Peak flow meters Asthma Glucometers Diabetes Hemoglobin A1c testing Diabetes International Normalized Ratio (INR) testing Liver disease and/or bleeding disorders Low-density Lipoprotein (LDL) testing Heart disease Statins Heart disease and/or diabetes Please refer to the Schedule of Benefits for further details on how benefits will be paid. Prosthetics Please see “Durable Medical Equipment (DME), Medical Devices, and Supplies” earlier in this section. Pulmonary Therapy Please see “Therapy Services” later in this section. Radiation Therapy Please see “Therapy Services” later in this section. Rehabilitation Services Benefits include services in a Hospital, free-standing Facility, Skilled Nursing Facility, or in an outpatient day rehabilitation program. Covered Services involve a coordinated team approach and several types of treatment, including skilled nursing care, physical, occupational, and speech therapy, and services of a social worker or psychologist.

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