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These outpatient benefits include covered services furnished by a licensed residential treatment facility.

These outpatient benefits include covered services furnished by a licensed residential treatment facility.

These outpatient benefits include covered services furnished by a licensed residential treatment facility.

Oral surgery. This includes: reduction of a dislocation or fracture of the jaw or facial bone; excision of a benign or malignant tumor of the jaw; and removal of impacted teeth that are fully or partially imbedded in the bone, removal of seven or more teeth (includes wisdom teeth) and orthognathic surgery that is needed to correct a significant functional impairment that cannot be adequately corrected with orthodontic services when the member has a serious medical condition that requires admission to a Surgical Day Care Unit of a hospital or to an Ambulatory Surgical Facility in order for the surgery to be safely performed. These benefits are also provided when the surgery is furnished at an oral surgeon's office.

In addition, this health plan also covers LASIK surgery furnished by an eye surgeon or ophthalomogist for the dollar amount described in the benefit limit.

Voluntary sterilization procedures (including reversal of voluntary sterilization procedures).

The benefit limit dollar amount does not apply to: blood tests to screen for lead poisoning; mammograms; Pap smear tests; routine sigmoidoscopies or barium enemas; and routine colonoscopies.

This health plan also covers outpatient private duty nursing furnished by a registered nurse (RN) or licensed practical nurse (LPN) when it is medically necessary for the member's condition and furnished for the treatment of an approved prolonged illness condition.

One exam (physical or GYN exam) each calendar year for a member age 19 or older.

Note: For covered transplants, benefits are also provided for: up to a maximum of $12,500 for organ or tissue procurement; and transportation and lodging costs for up to a maximum of $10,000 for each transplant.