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Atlantis Health Plan Member Handbook- POS

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ROUTINE GYNECOLOGICAL CARE

Routine gynecological services (including pap smears, an annual check-up and mammography screening when appropriate) are available to all female members of the Plan. When using In-Plan benefits, you may receive these services from your Primary Care Provider or you can go to the AHP participating gynecologist or obstetrician/gynecologist of your choice. The list of participating OB/GYN's is included in the AHP Provider Directory. If you choose to go to an OB/GYN for primary and preventive gynecological care, you are entitled to two (2) visits per year without a referral. In addition, you may self-refer for any follow-up services required as a result of such visits or an acute gynecological condition.

OBSTETRICAL/MATERNITY CARE

When using In-Plan benefits, you may select the participating AHP Obstetrician or Certified Nurse Midwife of your choice to provide all care necessary during the course of your pregnancy and delivery.

HOSPICE

Hospice services are a covered benefit, whether the services are provided directly at the hospice or through the hospice on an outpatient basis, for up to 210 days. Up to five (5) visits are provided for bereavement counseling for family members.

BEHAVIORAL HEATH CARE SERVICES

In-Plan Mental Health and Substance Abuse treatment services are provided by Atlantisí behavioral health care management program. The services include inpatient, outpatient, rehabilitation, and aftercare benefits. These benefits are subject to the terms and conditions described in your Subscriber Contract and the limitations shown in the Schedule of Benefits.

If you or a covered family member needs behavioral health services, simply call the Program at 1-800-469-5636. Clinical case managers are available 24 hours a day, 7 days a week. All calls are strictly confidential. Arrangements will be made for consultation and referral to an appropriate licensed specialist or participating facility. If, due to an emergency, you were unable to call the program prior to receiving care, you or a representative must contact the Program within 24 hours.

PRESCRIPTION DRUG & VISION CARE

Prescription Drug and Vision Care are Covered Services of some plans. Please check your Subscriber Contract, Schedule of Benefits or Group Rider to see if these benefits are applicable to your coverage.

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