 You are a Member on the date you receive the Services.  A Participating Provider determines that the Services are Medically Necessary.  The Services are provided, prescribed, authorized, or directed by a Participating Provider except where specifically noted to the contrary in this EOC.  You receive the Services from a Participating Provider, Participating Facility, or from a Participating Skilled Nursing Facility, except where specifically noted to the contrary in this EOC.  You receive prior authorization for the Services, if required under “Prior and Concurrent Authorization and Utilization Review” in the “How to Obtain Services” section. All Services are subject to the coverage requirements described in this “Benefit Details” section. Some Services are subject to benefit-specific exclusions and/or limitations and eligibility provisions, which are listed, when applicable, in each benefit section. A broader list of exclusions and limitations that apply to all benefits is provided under the “Benefit Exclusions and Limitations” section. All covered Services are subject to any applicable Cost Share as described in the “What You Pay” section and in the “Benefit Summary.” The benefits under this Plan are not subject to a pre-existing condition waiting period. 1. Accidental Injury to Teeth The Services of a licensed dentist will be covered for repair of accidental injury to sound, healthy, natural teeth. Evaluation of the injury and development of a written treatment plan must be completed within 30 days from the date of injury. Treatment must be completed within the period established in the treatment plan unless delay is medically indicated and the written treatment plan is modified. Accidental Injury to Teeth Exclusions  Conditions not directly resulting from the accident; and treatment not completed within the time period established in the written treatment plan.  Dental appliances and dentures.  Dental implants.  Dental Services for injuries to teeth caused by biting or chewing.  Hospital Services for dental care.  Orthodontic treatment.  Routine or preventive dental Services.  Services to correct malocclusion resulting from an accidental injury, except for emergency stabilization. 2. Administered Medications Administered Medications such as drugs, injectables, and radioactive materials used for therapeutic or diagnostic purposes, are covered if they are administered to you in a Participating Hospital, Participating Medical Office or during home visits. 3. Acupuncture Services Acupuncture Services are provided by a Participating Provider in the Participating Provider’s office. East Asian medicine practitioners use acupuncture to influence the health of the body by the insertion of very fine needles. Acupuncture treatment is primarily used to relieve pain, reduce inflammation, and promote healing. Covered Services include: EWCLGDED1983ACT0124 39 WAPEBB-CL-ACT