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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.

Note: The benefit limit described above does not apply to removal of seven or more permanent teeth, removal of impacted or unerupted teeth imbedded in bone, periodontal surgery involving two or more gum quadrants and adjunctive surgical procedures.

Self-referred benefits are limited to a benefit payment of $90 for each covered exam.

This health plan also covers one hearing aid (or one set of binaural hearing aids) for up to $1,500 for each member in each calendar year. This includes dispensing fees, acquisition costs, batteries and repair of the hearing aid.

This health plan also covers one hearing aid (or one set of binaural hearing aids) for up to $500 for each member in each calendar year. This includes dispensing fees, acquisition costs, batteries and repair of the hearing aid.

Periodontal surgery (once in each quadrant each 36 months).

Tooth extractions.

Note: These benefits are limited to services that are furnished within 90 days of the onset of the emergency or the accident.

These benefits also include outpatient emergency medical services (and follow-up care) furnished by a hospital outpatient department, Community Health Center, Physician, Dentist or Nurse Practitioner.

Note: Refer also to Lab Tests, X- rays and Other Tests for benefits for diagnostic lab tests and x-rays.