Issuer clarifies this is a covered benefit but stipulated under the Medical Policy and not written in the member materials.

Limit: 1.0 Item(s) per Year

Limit: 25.0 Visit(s) per Benefit Period

One hearing aid per ear every 48 months

Limit: 30.0 Visit(s) per Benefit Period

Exclusions: We do not pay Home Health Care Benefits for Dietician services, except as specified for diabetes self- management training; Homemaker services; Maintenance therapy; Speech Therapy; Durable Medical Equipment; Food or home - delivered meals; Intravenous drug, fluid, or nutritional therapy, except when you have received Preauthorization from the Plan for these services.

Limit: 25.0 Visit(s) per Benefit Period

Covered under Outpatient Therapy Services.

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Diabetes self-management training and training related to medical nutrition therapy.

Limit: 30.0 Days per Benefit Period

Cost share applies to both in-person and telemedicine services. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.

Limit: 85.0 Visit(s) per Benefit Period

Pre-authorization required.

Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.

Limit: 25.0 Visit(s) per Benefit Period

Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).

Limit: 25.0 Visit(s) per Benefit Period

Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).

Limit: 1.0 Exam(s) per Year

Limit: 30.0 Days per Benefit Period

Exclusions: No Benefits are available: Once you can no longer improve from treatment; or for Custodial Care, or care for someone's convenience.

Cost share applies to both in person and telemedicine services.

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: Exclusions and Limitations Applicable to Organ/Tissue/Bone Marrow Transplants: The transplant must meet the criteria established by the Plan for assessing and performing organ or tissue transplants, or Bone Marrow Transplant procedures, as set forth in the Plan's written medical policies. In addition to the Exclusions set forth elsewhere in this Certificate, no Benefits will be provided for the following organ or tissue transplants or Bone Marrow Transplants or related services: Adrenal to brain transplants; Allogeneic islet cell transplants; High-Dose Chemotherapy or High-Dose Radiation Therapy if the associated autologous or allogeneic Bone Marrow Transplant, stem cell or progenitor cell treatment, or rescue is not a Covered Service; Small bowel transplants using a living donor; Any organ or tissue transplant or Bone Marrow Transplant from a non- human donor or for the use of non-human organs for extracorporeal support and/or maintenance; Any artificial device for transplantation/implantation, except in limited instances as reflected in the Plan's written medical policies; Any organ or tissue transplant or Bone Marrow Transplant procedure which the Plan considers to be Experimental, Investigational and/or Unproven in nature; Expenses related to the purchase, evaluation, Procurement Services or transplant procedure if the organ or tissue or bone marrow or stem cells or progenitor cells are sold rather than donated to the Subscriber recipient; All services, provided directly for or relative to any organ or tissue transplant, or Bone Marrow Transplant procedure which is not specifically listed as a Covered Service in this Certificate. The transplant must be performed in and by a Provider that meets the criteria established by the Plan for assessing and selecting Providers in the performance of organ or tissue transplants or Bone Marrow Transplant procedures.

Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full.