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 50 they interact with others.) If a child who is under age 19 is receiving an ongoing course of treatment, this coverage will continue to be provided after the child’s 19th birthday until that ongoing course of treatment is completed, provided that the child or someone acting on behalf of the child continues to pay for coverage in this health plan in accordance with federal (COBRA) or state law, or the child enrolls with no lapse in coverage under another Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. or Blue Cross and Blue Shield of Massachusetts, Inc. health plan.  All other non-biologically-based mental conditions not described above. No benefits are provided for:  Psychiatric services for a condition that is not a mental condition.  Residential or other care that is custodial care.  Services and/or programs that are not medically necessary to treat your mental condition.  Services and/or programs that are performed in educational or vocational settings; or, services and/or programs that are not considered to be inpatient services, intermediate treatments, or outpatient services as described below in this section. These types of non-covered programs may be in residential or nonresidential settings and may include: therapeutic elements and therapy services; clinical staff (such as licensed mental health counselors) and clinical staff services; and vocational, educational, problem solving, and/or recreational activities. These non-covered programs may have state licensure and/or educational accreditation. But, they do not provide the clinically appropriate level of care required for coverage under this health plan. No benefits are provided for any services furnished along with one of these non-covered programs. The only exception is for outpatient covered services to diagnose and/or treat mental conditions when these services are performed by a covered provider. Your coverage for these covered services is provided to the same extent as coverage is provided for similar covered services to diagnose and treat a mental condition. Inpatient Services Usually, to receive coverage for inpatient services, you and your mental health provider must receive approval from Blue Cross Blue Shield HMO Blue as outlined in this Subscriber Certificate before you enter a hospital or other covered facility. (See Part 4 for these requirements.) Blue Cross Blue Shield HMO Blue will let you and your mental health provider know when your coverage is approved. When inpatient care is approved by Blue Cross Blue Shield HMO Blue, this health plan provides coverage for as many days as are medically necessary for you. This coverage includes: semiprivate room and board and special services; and psychiatric care that is furnished for you by a physician (who is a specialist in psychiatry), or by a psychologist, or by a clinical specialist in psychiatric and mental health nursing, or by another mental health provider. Intermediate Treatments There may be times when you will need medically necessary care that is more intensive than typical outpatient care. But, you do not need 24-hour inpatient hospital care. This intermediate care may include (but is not limited to):  Acute residential treatment (this is substantially similar to Community-Based Acute Treatment (CBAT) programs described below in this section), clinically managed detoxification services, or crisis stabilization services. These services may sometimes be referred to as sub-acute care services.