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This health plan covers a routine vision exam furnished by a Physician (who is an ophthalmologist) or an Optometrist and frames and/or prescription lenses (or contact lenses instead) up to the dollar amount described in the benefit limit.

The member's copayment is waived when covered services are furnished in the member's home.

The member's office visit copayment is waived when the visit is only for lab tests and/or x-rays or medical care services are furnished in the member's home.

IUDs and diaphragms when the items are supplied by the provider during the visit.

Routine hearing exams (including hearing tests that are part of a covered hearing exam) furnished by a covered health care provider for the number of exams described in the benefit limit.

The member's copayment is waived when the visit is only for a routine hearing test.

The member's copayment is waived when the member is admitted for inpatient care within 24 hours after the ambulance transport.

Food products modified to be low protein that are medically necessary to treat inherited diseases of amino acids and organic acids for up to $2,500 for each member in each calendar year. The member may buy these food products directly from a distributor.

Wigs (scalp hair prostheses) for up to $500 each calendar year when hair loss is due to: chemotherapy; radiation therapy; infections; burns; traumatic injury; congenital baldness; and medical conditions resulting in alopecia areata or alopecia totalis (capitus).

The value of the outpatient benefit limit will be at least $500 combined for all mental health and substance use treatment for each member in each calendar year (plus $500 more for alcoholism).