| Visit | First policy check | Next question |
|---|---|---|
| New illness or injury | Is the underlying event eligible? | Is accident/illness exam coverage included or selected? |
| Follow-up or specialist referral | Does the continuing condition remain eligible? | Does the exam wording extend to this consultation? |
| Routine annual examination | Is a preventive benefit present? | What service, frequency and dollar allowance does it provide? |
| Initial examination after enrollment | Why was the visit performed? | Is it routine screening, required enrollment documentation or care for an eligible new problem? |
| Visit about a prior condition | How does the prior-condition clause apply? | Does that exclusion also apply to the examination? |
Being the “first visit” does not by itself establish payment. An exam needed to document health for enrollment and an exam to treat an eligible injury can have different purposes. Request the exact rule instead of relying on sequence alone.