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 67  Voluntary termination of pregnancy (abortion).  Voluntary sterilization procedures. To provide coverage for the women’s preventive health services as recommended by the U.S. Department of Health and Human Services and, any in-network deductible, copayment, and/or coinsurance, whichever applies to you, will be waived for a sterilization procedure furnished for a female member when it is performed as the primary procedure for family planning reasons. Or, if you choose to have this service performed by a non-preferred provider, you must pay your deductible, when it applies, and 20% coinsurance. This is the case even if your health plan is a grandfathered health plan under the Affordable Care Act. This provision does not apply for hospital services. For all situations except as described in this paragraph, the cost share amount for elective surgery will still apply.  Endoscopic procedures.  Surgical procedures. This includes emergency and scheduled surgery. This coverage includes (but is not limited to):  Reconstructive surgery. This means non-dental surgery that is meant to improve or give you back bodily function or to correct a functional physical impairment that was caused by: a birth defect; a prior surgical procedure or disease; or an accidental injury. It also includes surgery to correct a deformity or disfigurement that was caused by an accidental injury. This coverage includes surgery to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome, when the covered provider has determined that this treatment is necessary to correct, repair, or lessen the effects of HIV associated lipodystrophy syndrome. These services include, but are not limited to: reconstructive surgery, such as suction-assisted lipectomy; other restorative procedures; and dermal injections or fillers for reversal of facial lipoatrophy syndrome. Women’s Health and Cancer Rights As required by federal law, this coverage includes breast reconstruction in connection with a mastectomy. This health plan provides coverage for: all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and treatment of physical complications at all stages of mastectomy, including lymphedemas. These services will be furnished in a manner determined in consultation with the attending physician and the patient.  Transplants. This means human organ (or tissue) and stem cell (“bone marrow”) transplants that are furnished according to Blue Cross Blue Shield HMO Blue medical policy and medical technology assessment criteria. This includes one or more stem cell transplants for a member who has been diagnosed with breast cancer that has spread and the member meets the standards that have been set by the Massachusetts Department of Public Health. For covered transplants, this coverage also includes: the harvesting of the donor’s organ (or tissue) or stem cells when the recipient is a member; and drug therapy during the transplant procedure to prevent the transplanted organ (or tissue) or stem cells from being rejected. “Harvesting” includes: the surgical removal of the donor’s organ (or tissue) or stem cells; and the related medically necessary services and/or tests that are required to perform the transplant itself. No benefits are