MEMBER SERVICES – VALUE ADDED SERVICES applied to the participating provider’s retail cost for the contact lenses and professional services specific to contact lens wear, e.g., fitting, assessment and follow-up. Members who elect to upgrade their eyewear purchase with a retail value greater than the $100 allowance are financially responsible for paying the participating provider’s usual and customary (retail) cost of the difference between the cost of the eyewear selected and the $100 allowance. Sports and School Physicals One each year for Members age 4 through 19 Disease Management Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs Help for Members with Asthma Asthma educational materials and one allergy-free pillowcase each year to Members enrolled in our Asthma Care Management Program. Member gets one pillowcase per year based on when Member received one before. Extra Help for Pregnant Women $25 gift card for completing a prenatal checkup within 42 days of enrollment. $25 gift card for completing a postpartum checkup within 21-56 days after giving birth Health and Wellness Services Up to $100 allowance toward an annual Baker Ripley membership in the Harris Service Area Healthy Play and Exercise Programs $30 gift card each year for school-aged Member up to grade 12 who are in a school-sponsored extracurricular sports (athletic) program to pay for program fees, supplies or uniforms Healthy Play and Exercise Programs $40 gift card each year for Members up to grade 12 who participate in a youth sports league (apart from extracurricular, school sponsored activities) Gift Card Program $10 gift card for each of up to six well-child checkups before turning 15 months old, plus a $25 bonus gift card for completing all six checkups, for a total of up to $85 Extra Dental Services for Adults (age 21 and older) and Pregnant Women Two routine dental exams per year with teeth cleaning, x-rays, fillings, non-surgical extractions, and emergency exams (limited) CHIP 24-Hour Advice Hotline Nurse Help Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals. Extra Vision Services Members receive a $100 allowance each year toward the choice of: (1) upgrades for frames, lenses, and lens options or (2) contact lenses. The benefit period is measured from the date of service. When contact lenses are chosen, the allowance is applied to the participating provider’s retail cost for the contact lenses and professional services specific to contact lens wear, e.g., fitting, assessment, and follow-up. Members who elect to upgrade their eyewear purchase with a retail value greater than the $100 allowance are financially responsible for paying the participating provider’s usual and customary (retail) cost of the difference between the cost of the eyewear selected and the $100 allowance. 6
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