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(These benefits may be reduced by any benefits that have already been provided for oxygen and equipment under a prior Blue Cross Blue Shield coverage in the same calendar year.)

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

This health plan covers routine Pap smear tests furnished by a General Hospital, Community Health Center, Physician, Nurse Practitioner, Nurse Midwife or Independent Lab for the number of tests described in the benefit limit.

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 the visit is only for lab tests and/or x-rays.

Routine Physical Exams and Related Services

Preventive Dental Services

This health plan covers preventive dental services furnished by a dentist. These covered services include:

Periodic or routine oral exams once each six months.

Routine cleaning, scaling and polishing of teeth once each six months.

The member's copayment is waived when the visit is only for immunizations.