The following rider products can only be purchased as additions to a basic HMO program. More detailed information on the specific benefits and limitations of each rider will be explained when you select your basic program.

Prescriptions
Mental Health/Substance Abuse
Skilled Nursing Facility
Vision
Student Coverage

Prescription Drug Coverage

You can enhance your health plan by adding valuable prescription drug benefits - with a choice of co-payments - to your coverage. You may have prescriptions filled at any participating pharmacy, or use our Mail Order/Maintenance program and have medications conveniently delivered to your home.

Atlantis Health Plan has four prescription options:

• $5 Co-pay
• $10 Co-pay
• $5/10 Co-pay
• 50% Co-pay

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Mental Health/Substance Abuse

• Outpatient Mental Health
• Four outpatient mental health riders are available. Each rider provides additional outpatient visits per calendar year and each visit is subject to a co-payment of 50% of the cost of the visit. The four riders provide for:
• 20 additional visits
• 30 additional visits
• 40 additional visits
• 50 additional visits
• Inpatient Mental Health
• This rider entitles the member to an additional 30 inpatient days per calendar year. Inpatient days are not subject to co-payment
• Inpatient Alcohol/Substance Abuse
• This rider entitles the member to an additional 30 inpatient days per calendar year. Inpatient days are not subject to a co-payment.

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Skilled Nursing Facility

This rider provides an additional 60 inpatient days per calendar year for medically necessary services in a Participating Skilled Nursing Facility. Services must constitute Skilled Nursing care as defined by Medicare Law. There is no co-payment for skilled nursing facility services.

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Vision

• High Option
  This rider entitles the member to an eye examination once every 12 months, with the benefit period measured from the date of service. In addition, the member is entitled to a $150.00 (retail) total eyewear allowance once every 24 months, with the benefit period measured from the date of service. Eyewear consists of a frame and/or lens combination or contact lenses. If the member elects to purchase contact lenses in lieu of eyeglasses, the member is required to pay the usual and customary charge for professional services beyond the standard eye exam for testing specific to contact lenses and evaluation. There is no co-payment for vision services.
• Low Option
  This rider entitles the member to an eye examination once every 12 months, with the benefit period measured from the date of service. The member is entitled to a $75.00 (retail) eyewear allowance once every 24 months, with the benefit period measured from the date of service. Eyewear consists of a frame and/or lens combination or contact lenses. There is a $10 co-payment for vision services.

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Student Coverage

Age 23
This rider increases the age of dependent eligibility to 23 as long as the dependent attends school on a full time basis.

Age 25
This rider increases the age of dependent eligibility to age 25 as long as the dependent attends school on a full time basis.

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