Part 5 – Covered Services (continued) IMPORTANT: Refer to the Schedule of Benefits for your plan option for the cost share amounts that you must pay for covered services and for the benefit limits that may apply to specific covered services. Once you reach your benefit limit for a specific covered service, no more benefits are provided by Blue Cross Blue Shield HMO Blue for those services or supplies. WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 47  Newborn hearing screening tests that are performed by a covered provider before the newborn child (an infant under three months of age) is discharged to the care of the parent or guardian, or as provided by regulations of the Massachusetts Department of Public Health. See “Admissions for Inpatient Medical and Surgical Care” for your coverage when an enrolled newborn child requires medically necessary inpatient care. Medical Care Outpatient Visits This health plan covers outpatient care to diagnose or treat your medical condition when the services or supplies are furnished for you by a covered provider. This may include (but is not limited to): a physician; or a nurse practitioner; or an optometrist; or a licensed dietitian nutritionist. These services may be furnished in the provider’s office or at a covered facility or, as determined appropriate by Blue Cross Blue Shield HMO Blue, at home. This coverage includes:  Medical care services to diagnose or treat your illness, condition, or injury. These medical services also include (but are not limited to): nutrition counseling; and health education services. Women’s Health and Cancer Rights As required by federal law, this coverage includes medical care services to treat physical complications at all stages of mastectomy, including lymphedemas and breast reconstruction in connection with a mastectomy. These services will be furnished in a manner determined in consultation with the attending physician and the patient.  Certain medical care services you receive from a limited services clinic. A limited services clinic can provide on-the-spot, non-emergency care for symptoms such as a sore throat, cough, earache, fatigue, poison ivy, flu, body aches, or infection. You do not need an appointment to receive this care. If you want to find out if a specific service is covered at a limited services clinic, you can call the limited services clinic or you can call the Blue Cross Blue Shield HMO Blue customer service office. Generally, the cost share amount you pay for these covered services is the same cost share amount that you would pay for similar services furnished by a physician. Refer to the Schedule of Benefits for your plan option for your cost share amount when you receive covered services at a limited services clinic.  Medical exams and contact lenses that are needed to treat keratoconus. And, for members with certain conditions as outlined in the Blue Cross Blue Shield HMO Blue medical policy, coverage is also provided for medical exams and rigid gas permeable scleral contact lenses. This includes the cost of the fitting of these contact lenses for these conditions.  Hormone replacement therapy for peri- and post-menopausal members.  Urgent care services.  Follow up care that is related to an accidental injury or an emergency medical condition.  Acupuncture services by a covered provider who is licensed to furnish the covered service, whether or not these services are medically necessary. This health plan provides coverage only until you reach your benefit limit. The Schedule of Benefits for your plan option describes the cost share amount and benefit limit that applies for these covered services. Once you reach the benefit limit, no more benefits