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Non-dental surgery and necessary postoperative care furnished by a Dentist.

Necessary postoperative care after covered inpatient or outpatient surgery.

Termination of pregnancy (abortion) to prevent the death of the mother and voluntary sterilization procedures.

The member's copayment is waived when surgery or medical care services are furnished at a hospital, Surgical Day Care Unit or Ambulatory Surgical Facility or medical care services are furnished in the member's home or the visit is only for x-rays.

The member's office visit copayment is waived when medical care services are furnished at a hospital (unless the provider's office is located at or professional charges are billed by the hospital) or in the member's home or the visit is only for x-rays.

Non-biologically-based mental, behavior or emotional disorders of enrolled dependent children under age 19. (In this case, these benefits also include inpatient admissions in a Substance Use Treatment Facility.)

(These benefits may be reduced by any benefits that have already been provided for these covered services under a prior Blue Cross Blue Shield non-HMO coverage in the same calendar year.)

(The number of routine pediatric visits available under this coverage may be reduced by visits used in the same eligible time period under a prior Blue Cross Blue Shield non-HMO coverage.)

This health plan covers preventive dental care for enrolled dependent children under age 12 when the services are furnished by a Dentist that has a participating agreement with Blue Cross Blue Shield. These covered services include:

One complete initial oral exam by the child's Dentist.