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This Medex plan covers family planning services furnished by a Community Health Center, Physician, Nurse Practitioner or Nurse Midwife. These covered services include:

Diagnostic tests (including pregnancy tests).

Routine medical exams (including birth control counseling and genetic counseling).

Note: For these services, the member must pay a $180 copayment for the implant system itself.

IUDs and diaphragms when the items are supplied by the provider during the visit.

Dentists' inpatient services for surgical removal of unerupted teeth or impacted teeth when imbedded in bone, extraction of seven or more permanent teeth, gingivectomies involving two or more gum quadrants, gingival flap, mucogingival surgery, oseous graft and soft tissue graft.

This Medex plan covers medical care services to diagnose and/or treat an illness or injury when furnished by a Physician or Nurse Practitioner. These benefits include:

Office and home visits. (Refer to Prescription Drugs for more information about chemotherapy and other drugs that are administered by a Medicare covered provider.)

Note: In the event that a preferred network has not been established for acupuncturists, in-network benefits will be provided for covered services furnished by any licensed Acupuncturist.

Smoking cessation aids that require a prescription by law. These benefits are limited to a 90-day supply for each member in each calendar year.