Common use of Early Intervention Services (EIS) Clause in Contracts

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Emergency Room Services Hospital emergency room $200 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 per hearing aid for a member under 21, the benefit limit is $700 per hearing aid for a member 21 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Emergency Room Services Hospital emergency room $200 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 per hearing aid for a member under 21, the benefit limit is $700 per hearing aid for a member 21 and olderaid. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Emergency Room Services Hospital emergency room $200 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. 0%** Education - Asthma Asthma management 0% $25 20% plus $25 - After deductible Emergency Room Services Hospital emergency room $200 The level of coverage is the same as network provider. 100 $100** Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 25 20% plus $25 - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. 20% - After deductible** Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% $40 20% plus $40 - After deductible Afterdeductible Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 40 20% plus $40 - After deductible Afterdeductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Not Covered Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 30 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 per hearing aid for a member under 21, the benefit limit is $700 per hearing aid for a member 21 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 30 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% 20% - After deductible Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 30 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 per hearing aid for a member under 21, the benefit limit is $700 per hearing aid for a member 21 and olderaid. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% $40 20% plus $40 - After deductible Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 40 20% plus $40 - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% $15 20% - After deductible Emergency Room Services Hospital emergency room $200 50 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 15 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. 0% Education - Asthma Asthma management 0% $40 20% - After deductible Emergency Room Services Hospital emergency room $200 The level of coverage is the same as network provider. 150 $150 Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 40 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. 20% - After deductible Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% $40 20% plus $40 - After deductible Afterdeductible Emergency Room Services Hospital emergency room $200 150 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 40 20% plus $40 - After deductible Afterdeductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, the benefit limit is $700 per hearing aid for a member 21 and olderaid. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible

Early Intervention Services (EIS). Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider. Education - Asthma Asthma management 0% $25 20% - After deductible Emergency Room Services Hospital emergency room $200 100 The level of coverage is the same as network provider. Experimental and Investigational Services Coverage varies based on type of service. Hearing Services Hearing exam $50 25 20% - After deductible Hearing diagnostic testing 0% 20% - After deductible Hearing aids - The benefit limit is $2,000 1,500 per hearing aid for a member under 21, 19; the benefit limit is $700 per hearing aid for a member 21 19 and older. 20% - After deductible The level of coverage is the same as network provider. Home Health Care* Intermittent skilled services when billed by a home health care agency. 0% - After deductible 20% - After deductible