AMERICAN SPECIALTY HEALTH PLANS GROUP SUBSCRIBER AGMT 1998

~ • ATTACHMENT A AMERICAN SPECIALTY HEATLH PLANS FORMERLYAMERICANCHIROPRACTICNETWORKHEALTHPLAN, INC. SCHEDULE OF BENEFITS page 2 PLAN: CH3 No Deductibles; $12 Copayment Per Visit; 30 Visit Annual Maximum All services, other than initial examination and emergency services require ASHP authorization. EXCLUSIONS AND LIMITATIONS In addition to any other applicable "limitations" contained elsewhere in this Evidence of Coverage, ASHP shall not be required to furnish benefits in connection with the following: a) .Services or treatments furnished by chiropractors who do not contract with ASHP for the delivery of chiropractic care to eligible Members, except for Emergency Services. b) Examination and/or treatments for conditions other than those related to Neuro-Muscularskeletal Disorders. c) Physical therapy not associated with spinal, muscle or joint manipulation. d) Hypnotherapy, behavior training, sleep therapy and weight programs. e) Thermography. f) Lab tests and x-rays and other treatments classified as experimental, and/or as being in the research stage. g) Services and/or treatments which are not documented as chiropractically necessary. h) Magnetic Resonance Imaging, CAT Scans and any types of diagnostic radiology, other than radiological x-rays. i) Transportation costs including local ambulance charges. j) Education programs, non-medical self-care, or help training or any related diagnostic testing. k) Vitamins, minerals, nutritional supplements or other similar products. 1) Durable Medical Equipment except as defined elsewhere in this Exhibit A. m) Prescription drugs or medicines including anon-legend or proprietary medicine or medication not requiring a prescription order. n) Services provide by a chiropractor practicing outside the State of California. o) Hospitalization, anesthesia, manipulation under anesthesia, or other related services.