Common use of COVERED HEALTH CARE SERVICES Clause in Contracts

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 3.7 Dialysis Services 26 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 3.9 Early Intervention Services (EIS) 30 3.10 Education 31 3.11 Experimental/Investigational Services 32 3.12 Hearing Services 34 3.13 Hemophilia Services 35 3.14 Home Health Care 35 3.15 Hospice Care 36 3.16 Hospital Emergency Room Services 36 3.17 Human Leukocyte Antigen Testing 37 3.18 Infertility Services 38 3.19 Infusion Therapy 38 3.20 Inpatient Hospital Services 39 3.21 Inpatient Doctors' Hospital Visits 39 3.22 Inpatient Rehabilitation Facility 40 3.23 Office Visits 40 3.24 Organ Transplants 42 3.25 Physical/Occupational Therapy 43 3.26 Pregnancy Services and Nursery Care 44 3.27 Prescription Drugs and Diabetic Equipment/Supplies 45

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 29 3.7 Dialysis Services 26 30 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 30 3.9 Early Intervention Services (EIS) 30 34 3.10 Education 31 34 3.11 Experimental/Investigational Services 32 35 3.12 Hearing Services 34 37 3.13 Hemophilia Services 35 38 3.14 Home Health Care 35 38 3.15 Hospice Care 36 39 3.16 Hospital Emergency Room Services 36 39 3.17 Human Leukocyte Antigen Testing 37 40 3.18 Infertility Services 38 41 3.19 Infusion Therapy 38 41 3.20 Inpatient Hospital Services 39 42 3.21 Inpatient Doctors' Hospital Visits 39 42 3.22 Inpatient Rehabilitation Facility 40 43 3.23 Office Visits 40 43 3.24 Organ Transplants 42 45 3.25 Physical/Occupational Therapy 43 46 3.26 Pregnancy Services and Nursery Care 44 47 3.27 Prescription Drugs and Diabetic Equipment/Supplies 4548 3.28 Preventive Care Services and Early Detection Services 61 3.29 Private Duty Nursing Services 64 3.30 Radiation Therapy/Chemotherapy Services 64 3.31 Respiratory Therapy 65 3.32 Skilled Care in a Nursing Facility 66 3.33 Speech Therapy 66 3.34 Surgery Services 67 3.35 Telemedicine Services 71

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 29 3.7 Dialysis Services 26 30 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 30 3.9 Early Intervention Services (EIS) 30 34 3.10 Education 31 35 3.11 Experimental/Investigational Services 32 35 3.12 Hearing Services 34 38 3.13 Hemophilia Services 35 38 3.14 Home Health Care 35 38 3.15 Hospice Care 36 39 3.16 Hospital Emergency Room Services 36 40 3.17 Human Leukocyte Antigen Testing 37 41 3.18 Infertility Services 38 41 3.19 Infusion Therapy 38 41 3.20 Inpatient Hospital Services 39 42 3.21 Inpatient Doctors' Hospital Visits 39 43 3.22 Inpatient Rehabilitation Facility 40 43 3.23 Office Visits 40 44 3.24 Organ Transplants 42 45 3.25 Physical/Occupational Therapy 43 46 3.26 Pregnancy Services and Nursery Care 44 47 3.27 Prescription Drugs and Diabetic Equipment/Supplies 4549 3.28 Preventive Care Services and Early Detection Services 61 3.29 Private Duty Nursing Services 64 3.30 Radiation Therapy/Chemotherapy Services 65 3.31 Respiratory Therapy 66 3.32 Skilled Care in a Nursing Facility 66 3.33 Speech Therapy 66 3.34 Surgery Services 68 3.35 Telemedicine Services 71

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 3.7 Dialysis Services 26 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 3.9 Early Intervention Services (EIS) 30 3.10 Education 31 3.11 Experimental/Investigational Services 32 3.12 Hearing Services 34 3.13 Hemophilia Services 35 3.14 Home Health Care 35 3.15 Hospice Care 36 3.16 Hospital Emergency Room Services 36 3.17 Human Leukocyte Antigen Testing 37 3.18 Infertility Services 38 3.19 Infusion Therapy 38 mexic38 3.20 Inpatient Hospital Services 39 3.21 Inpatient Doctors' Hospital Visits 39 3.22 Inpatient Rehabilitation Facility 40 3.23 Office Visits 40 3.24 Organ Transplants 42 3.25 Physical/Occupational Therapy 43 3.26 Pregnancy Services and Nursery Care 44 3.27 Prescription Drugs and Diabetic Equipment/Supplies 45

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 29 3.7 Dialysis Services 26 30 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 30 3.9 Early Intervention Services (EIS) 30 34 3.10 Education 31 35 3.11 Experimental/Investigational Services 32 35 3.12 Hearing Services 34 38 3.13 Hemophilia Services 35 38 3.14 Home Health Care 35 38 3.15 Hospice Care 36 39 3.16 Hospital Emergency Room Services 36 40 3.17 Human Leukocyte Antigen Testing 37 41 3.18 Infertility Services 38 41 3.19 Infusion Therapy 38 41 3.20 Inpatient Hospital Services 39 42 3.21 Inpatient Doctors' Hospital Visits 39 43 3.22 Inpatient Rehabilitation Facility 40 43 3.23 Office Visits 40 43 3.24 Organ Transplants 42 45 3.25 Physical/Occupational Therapy 43 46 3.26 Pregnancy Services and Nursery Care 44 47 3.27 Prescription Drugs and Diabetic Equipment/Supplies 4549 3.28 Preventive Care Services and Early Detection Services 61 3.29 Private Duty Nursing Services 64 3.30 Radiation Therapy/Chemotherapy Services 65 3.31 Respiratory Therapy 65 3.32 Skilled Care in a Nursing Facility 66 3.33 Speech Therapy 66 3.34 Surgery Services 67 3.35 Telemedicine Services 71

COVERED HEALTH CARE SERVICES. 16 24 3.1 Ambulance Services 16 24 3.2 Autism Services 25 3.3 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 26 3.4 Cardiac Rehabilitation 24 3.4 31 3.5 Chiropractic Medicine 24 3.5 31 3.6 Dental Care 25 3.6 32 3.7 Diabetic Equipment and Supplies 26 3.7 33 3.8 Dialysis Services 26 3.8 34 3.9 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 3.9 34 3.10 Early Intervention Services (EIS) 30 3.10 37 3.11 Education 31 3.11 38 3.12 Emergency Room Services 38 3.13 Experimental/Investigational Services 32 3.12 39 3.14 Gender Reassignment Services 41 3.15 Hearing Services 34 3.13 Hemophilia Services 35 3.14 42 3.16 Home Health Care 35 3.15 42 3.17 Hospice Care 36 3.16 Hospital Emergency Room Services 36 3.17 43 3.18 Human Leukocyte Antigen Testing 37 3.18 43 3.19 Infertility Services 38 3.19 44 3.20 Infusion Therapy 38 3.20 44 3.21 Inpatient Hospital Services 39 3.21 45 3.22 Inpatient Doctors' Hospital Visits 39 3.22 45 3.23 Inpatient Rehabilitation Facility 40 3.23 45 3.24 Office Visits 40 3.24 45 3.25 Organ Transplants 42 3.25 47 3.26 Physical/Occupational Therapy 43 3.26 48 3.27 Pregnancy Services and Nursery Care 44 3.27 49 3.28 Prescription Drugs and Diabetic Equipment/Supplies 4550 3.29 Preventive Care Services and Early Detection Services 54 3.30 Private Duty Nursing Services 57 3.31 Radiation Therapy/Chemotherapy Services 57 3.32 Respiratory Therapy 58 3.33 Skilled Care in a Nursing Facility 58 3.34 Speech Therapy 58 3.35 Surgery Services 59 3.36 Telemedicine Services 63

COVERED HEALTH CARE SERVICES. 16 15 3.1 Ambulance Services 16 15 3.2 Behavioral Health Services 18 17 A. Mental Health Services 19 18 B. Substance Use Disorder Treatment 21 20 3.3 Cardiac Rehabilitation 24 23 3.4 Chiropractic Medicine 24 23 3.5 Dental Care 25 24 3.6 Diabetic Equipment and Supplies 26 28 3.7 Dialysis Services 26 29 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 29 3.9 Early Intervention Services (EIS) 30 33 3.10 Education 31 34 3.11 Experimental/Investigational Services 32 34 3.12 Hearing Services 34 37 3.13 Hemophilia Services 35 37 3.14 Home Health Care 35 37 3.15 Hospice Care 36 38 3.16 Hospital Emergency Room Services 36 39 3.17 Human Leukocyte Antigen Testing 37 40 3.18 Infertility Services 38 40 3.19 Infusion Therapy 38 40 3.20 Inpatient Hospital Services 39 41 3.21 Inpatient Doctors' Hospital Visits 39 42 3.22 Inpatient Rehabilitation Facility 40 42 3.23 Office Visits 40 42 3.24 Organ Transplants 42 44 3.25 Physical/Occupational Therapy 43 45 3.26 Pregnancy Services and Nursery Care 44 46 3.27 Prescription Drugs and Diabetic Equipment/Supplies 4548 3.28 Preventive Care Services and Early Detection Services 60 3.29 Private Duty Nursing Services 63 3.30 Radiation Therapy/Chemotherapy Services 64 3.31 Respiratory Therapy 64 3.32 Skilled Care in a Nursing Facility 65 3.33 Speech Therapy 65 3.34 Surgery Services 66 3.35 Telemedicine Services 70

COVERED HEALTH CARE SERVICES. 16 3.1 Ambulance Services 16 3.2 Behavioral Health Services 18 A. Mental Health Services 19 B. Substance Use Disorder Treatment 21 3.3 Cardiac Rehabilitation 24 3.4 Chiropractic Medicine 24 3.5 Dental Care 25 3.6 Diabetic Equipment and Supplies 26 3.7 Dialysis Services 26 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 3.9 Early Intervention Services (EIS) 30 3.10 Education 31 3.11 Experimental/Investigational Services 32 31 3.12 Hearing Services 34 3.13 Hemophilia Services 35 3.14 Home Health Care 35 3.15 Hospice Care 36 3.16 Hospital Emergency Room Services 36 3.17 Human Leukocyte Antigen Testing 37 3.18 Infertility Services 38 37 3.19 Infusion Therapy 38 3.20 Inpatient Hospital Services 39 3.21 Inpatient Doctors' Hospital Visits 39 3.22 Inpatient Rehabilitation Facility 40 3.23 Office Visits 40 3.24 Organ Transplants 42 3.25 Physical/Occupational Therapy 43 3.26 Pregnancy Services and Nursery Care 44 3.27 Prescription Drugs and Diabetic Equipment/Supplies 45

COVERED HEALTH CARE SERVICES. 16 18 3.1 Ambulance Services 16 19 3.2 Behavioral Health Services 18 21 A. Mental Health Services 19 22 B. Substance Use Disorder Treatment 21 24 3.3 Cardiac Rehabilitation 24 27 3.4 Chiropractic Medicine 24 27 3.5 Dental Care 25 28 3.6 Diabetic Equipment and Supplies 26 32 3.7 Dialysis Services 26 33 3.8 Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Devices 27 34 3.9 Early Intervention Services (EIS) 30 37 3.10 Education 31 38 3.11 Experimental/Investigational Services 32 38 3.12 Hearing Services 34 41 3.13 Hemophilia Services 35 42 3.14 Home Health Care 35 42 3.15 Hospice Care 36 43 3.16 Hospital Emergency Room Services 36 43 3.17 Human Leukocyte Antigen Testing 37 44 3.18 Infertility Services 38 45 3.19 Infusion Therapy 38 45 3.20 Inpatient Hospital Services 39 46 3.21 Inpatient Doctors' Hospital Visits 39 46 3.22 Inpatient Rehabilitation Facility 40 47 3.23 Office Visits 40 47 3.24 Organ Transplants 42 49 3.25 Physical/Occupational Therapy 43 and Pulmonary Rehabilitation 50 3.26 Pregnancy Services and Nursery Care 44 51 3.27 Prescription Drugs and Diabetic Equipment/Supplies 4553