64 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 office visit may not be payable under the preventive services benefit. If the primary purpose of the office visit is not for a preventive 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 visits under the Preventive Service benefit. • If a preventive item or service is billed separately 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 preventive 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 service, then the Plan will impose cost sharing with respect to the office visit. For example, if a covered individual schedules an in-network office visit to discuss recurring abdominal pain, and during the office visit the individual has a blood pressure screening, the office visit will be covered subject to the Plan’s cost sharing requirements, e.g., the deductible, if not already satisfied, and coinsurance, or 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. Note: Services performed as the result of medical symptoms or due to a known or suspected medical condition are not covered under this benefit. Such services would be considered under the related medical benefit where appropriate, subject to the deductible and applicable Payment Percentage for the service provided. Well child annual physical exams recommended in the Bright Futures Recommendations (for children from birth through age 21) are treated as preventive services and paid at 100% when received from an in-network provider. Note: Covered preventive services and items that are required by federal law are not subject to the deductible and will be paid at 100% when received from an in-network provider. Covered preventive services received from an out-of-network provider are not subject to the deductible, but the out-of- network Payment Percentage will apply. Please contact Quantum at if you have any questions about what preventive services are covered, or if you need help finding an in-network provider. Routine Examinations The following charges for routine examinations are covered medical benefits under the terms of the Plan. • Charges for annual complete physical exam. • Charges for annual gynecological exam for female participants. • Charges for routine well-child visits for children, including developmental assessment and anticipatory guidance.