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A routine sigmoidoscopy once every five years for a member age 50 or older.

Note: The benefits for a routine sigmoidoscopy or a routine colonoscopy are paid to the same extent that benefits are paid for surgical services.

Six visits during the first year of life (birth to 12 months). These six visits include inpatient pediatric care for a well newborn.

Three visits during the second year of life (12 months to 24 months).

One visit each calendar year from 24 months through age 18.

Diagnostic tests (other than hearing exams and tests).

Note: These benefits for insulin infusion pumps and related pump supplies are covered to the same extent as durable medical equipment.

Note: Benefits for inpatient and outpatient services furnished by a Podiatrist are limited to a total of $500 for each member in each calendar year.

Note: These benefits are available only when the admission meets all of Medicare's rules and requirements for a covered stay in a Skilled Nursing Facility.

Physical therapy furnished by an Independent Physical Therapist.