Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and Pap smear(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of covered Infertility services. • Routine Eye Examinations, including refraction, as follows:
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Dermatologists. Benefits are provided for Members for dermatological services performed by a Participating Dermatologist limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. • Routine Gynecological Examination(s) and Open Access to Gynecologists. Routine gynecological visit(s) and pap smear(s). The number of visits, if any, is listed on the Schedule of Benefits. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of Infertility benefits. • Direct Access to Chiropractors. Benefits are provided for Members for chiropractic services performed by a Participating Chiropractor limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Podiatrists. Benefits are provided for Members for podiatry services performed by a Participating Podiatrist limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. • Routine Eye Examinations, including refraction, as follows:
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and pap smear(s). The number of visits, if any, is listed on the Schedule of Benefits. • Open Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of Infertility benefits. • Direct Access to Dermatologists. Benefits are provided for Members for dermatological services performed by a Participating Dermatologist. • Routine Eye Examinations, including refraction, as follows:
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and Pap smear(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of Infertility benefits. • Direct Access to Participating Optometrists and Ophthalmologists for Medical Emergency. Member will be covered for up to two (2) visits, one initial and one follow-up visit, without referral from PCP. The Optometrist or Ophthalmologist will submit a report containing the Member’s complaint, history, exam results, initial diagnosis and treatment recommendations to the Member’s PCP within three (3) working days. HMO and Member will not be liable for any services rendered if the Provider fails to submit this report within three (3) working days. • Routine Eye Examinations, including refraction, as follows:
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and Pap smear(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. • Mammography (for benefit details, please see the Preventive Health Care Services and Diagnostic Services Benefits provisions under the Covered Benefit section). • Coverage is provided for non-routine eye examination, diagnosis and treatment of conditions and diseases of the eye and related eye structures. A Referral from the Member's PCP is required for inpatient Hospital or surgical services. • Routine Eye Examinations, including refraction, as follows:
Direct Access Specialist Benefits. 1. The following services are covered without a Referral when rendered by a Participating Provider other than the Member’s PCP. The Member must select a Participating gynecologist or obstetrician in her PCP’s Medical Group or IPA. • Routine Gynecological Examination(s). Routine gynecological visit(s), Pap smear(s) and Human Papilloma Virus screening(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems.
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and Pap smear(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Women’s Health Care Specialists. Benefits are provided to female Members for services performed by a Participating Women’s Health Care Specialist for preventive gynecological care, diagnosis and treatment of gynecological problems, maternity care, and reproductive services to the extent they are covered under this Certificate. If the Member self- refers to a Participating Women’s Health Care Specialist for one of the conditions listed above, and the Participating Women’s Health Care Specialist diagnoses an additional health problem during the course of the visit, covered services provided during the course of the visit to treat the additional health problem will also be covered. Covered, Medically Necessary laboratory services, imaging services, diagnostic services or prescription drugs or supplies (to the extent they are covered under this Certificate) ordered by the Participating Women’s Health Care Specialist will also be covered without prior Referral from the Member’s PCP. Certain Covered Benefits require preauthorization by HMO whether provided by the Member’s PCP or Women’s Health Care Specialist. See the Infertility Services section of this Certificate for a description of covered Infertility services.
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Routine Gynecological Examination(s). Routine gynecological visit(s) and Pap smear (s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. Direct access includes care related to pregnancy; care for all active gynecological conditions; and diagnosis, treatment and Referral for any disease or condition which is within the scope of the professional OB/GYN practice.
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider other than the Member’s PCP. The Member must select a Participating gynecologist or obstetrician in her PCP’s Medical Group or IPA. • Routine Gynecological Examination(s). Routine gynecological visit(s), Pap smear(s) and Human Papilloma Virus screening(s). The maximum number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. Routine Eye Examinations are covered as shown below without a Referral when rendered by a Provider identified in the Provider Directory as participating in the Direct Access Eye program. • Routine Eye Examinations, including refraction, as follows:
