48 Zoster; Hepatitis A; Hepatitis B; Meningococcal; and Varicella; • Immunization vaccines for children from birth to age 18 — doses, recommended ages and recommended populations must be satisfied: Hepatiti s B; Rotavirus; Diphtheria/tetanus/pertussis; Haemophilus influenzae type b; Pneumococcal; Inactivated Poliovirus; Influenza; Measles/mumps/rubella; Varicella; Hepatitis A; Meningococcal; and Human papillomavirus (HPV). Office Visit Coverage Preventive services are paid based on the Plan’s payment schedules for the individual services. However, there are situations in which an offic e visit may not be payable under the preventive services benefit. If the primary purpose of the office visit is not for a pr eventive item or service, then the Plan will impose cost sharing with respect to the office visit. The following conditions apply to payment for in - network office vis its under the Preventive Service benefit. • If a preventive item or service is billed separ ately from an office visit, then the Plan will impose cost sharing with respect to the office visit. • If the preventive item or service is not billed separately from the office visit, and the primary purpose of the office visit is the delivery of such preve ntive item or service, then the Plan will pay 100 percent for the office visit. • If the preventive item or service is not billed separately from the office visit, and the primary purpose of the office visit is not the delivery of such preventive item or ser vice, then the Plan will impose cost sharing with respect to the office visit. For example, if a covered individual schedules an office visit to discuss recurring abdominal pain, and during the office visit the individual has a blood pressure screening, th e office visit will be covered subject to the Plan’s cost sharing requirements, e.g., copayment , because the blood pressure screening was provided as part of an office visit, for which the primary purpose was not to deliver recommended preventive items or services.
2018 BTF Plan C Page 52 Page 54