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23 <br /> 10/0 PLAN <br /> I. HEALTH SERVICES FROM <br /> PARTICIPATING PHYSICIANS <br /> A. Office Visits $10 Copayment <br /> Office visits are <br /> comprehensive. <br /> Some types of office <br /> visit services include: <br /> * Periodic Health Examinations <br /> * Medical Consultation Services <br /> * Medical Referral Services to <br /> Participating Physicians <br /> * Routine Well Child Care <br /> * Voluntary Family Planning <br /> B. Diagnostic Services Full Coverage <br /> C. Laboratory Services Full Coverage <br /> D. Casts and Dressings Full Coverage <br /> E. Maternity Care $10 copayment for first <br /> Pre-natal and office visit then full <br /> Post Partum Care coverage. <br /> F. Immunizations and Full Coverage <br /> Injections <br /> G. Allergy Diagnostic 20% Copayment <br /> and Treatments <br /> Allergy Shots Up to $10 <br /> Copayment <br /> H. Routine Eye Exams, $15 Copayment <br /> including a re- <br /> fraction. One every <br /> two years. <br /> I. Hearing Examine- $15 Copayment <br /> tions. One per year. <br /> 4 <br /> 19 <br /> AW <br />