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Eyewear (prescription eyeglasses or contact lenses) once during the time period described in the benefit limit. These covered services are limited to standard single vision, bifocal or trifocal eyeglasses or contact lenses.

Note: This health plan also covers: contact lenses when they are needed to treat keratoconus; one pair of eyeglasses or contact lenses that are needed after a cataract surgery with insertion of an intraocular lens; and corrective lenses after cataract removal without a lens implant. These benefits are not subject to the benefit limit described for other covered eyewear.

This health plan covers Medicare-covered ambulance transport. These covered services include:

Ambulance transport to an emergency medical facility for emergency medical care. For example, covered ambulance services include transport from an accident scene or to a hospital due to symptoms of a heart attack.

Surgical services, including related anesthesia.

This health plan covers whole blood, blood components and blood storage fees.

This health plan covers Medicare-covered durable medical equipment and prosthetic devices (and related supplies) obtained from a covered appliance provider. These covered services include:

This health plan covers oxygen and oxygen equipment furnished by a covered provider. (These items are classified the same as durable medical equipment.)

Medicare provides full benefits for hospice services in a Medicare-certified hospice. (This health plan does not cover these services.)

This health plan covers home health care furnished by a covered home health care provider. These covered services include: