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This health plan covers outpatient surgical services furnished by a Physician or Nurse Practitioner. These covered services include:

This health plan covers temporomandibular joint (TMJ) disorder treatment furnished by a Physician or Dentist. These covered services include:

Delivery of one or more than one baby, including prenatal and postnatal medical care by a Physician or Nurse Midwife.

Inpatient psychiatric care furnished by a Physician (who is a specialist in psychiatry), Psychologist or Clinical Specialist in Psychiatric and Mental Health Nursing during admissions in a General or Mental Hospital.

Outpatient services furnished by a Clinical Specialist in Psychiatric and Mental Health Nursing, Licensed Independent Clinical Social Worker, Licensed Mental Health Counselor, Physician, Psychologist, Licensed Marriage and Family Therapist (effective May 1, 2008) or Psychiatric Nurse Practitioner (effective October 1, 2008).

Inpatient psychiatric care furnished by a Physician (who is a specialist in psychiatry), Psychologist or Clinical Specialist in Psychiatric and Mental Health Nursing during admissions in a General or Mental Hospital, Detoxification Facility or Alcohol and Drug Treatment Facility up to the number of days described in the benefit limit.

Outpatient services up to the number of visits described in the benefit limit. This includes services furnished by a Clinical Specialist in Psychiatric and Mental Health Nursing, Licensed Independent Clinical Social Worker, Licensed Mental Health Counselor, Physician, Psychologist, Licensed Marriage and Family Therapist (effective May 1, 2008) or Psychiatric Nurse Practitioner (effective October 1, 2008).

Inpatient psychiatric care furnished by a Physician (who is a specialist in psychiatry), Psychologist or Clinical Specialist in Psychiatric and Mental Health Nursing during admissions in a General or Mental Hospital, Detoxification Facility or Alcohol and Drug Treatment Facility up to the number of days described in the benefit limit.

Outpatient services up to the number of visits described in the benefit limit. This includes services furnished by a Clinical Specialist in Psychiatric and Mental Health Nursing, Licensed Independent Clinical Social Worker, Licensed Mental Health Counselor, Physician, Psychologist, Licensed Marriage and Family Therapist (effective May 1, 2008) or Psychiatric Nurse Practitioner (effective October 1, 2008).

This health plan covers routine pediatric care furnished by a Physician or Nurse Practitioner in accordance with the age-based schedule described in this section. These covered services include: