56 Reconstructive Surgery Benefits include reconstructive surgery to correct significant deformities caused by congenital or developmental abnormalities, illness, injury or an earlier treatment in order to create a more normal appearance. Benefits include surgery performed to restore symmetry after a mastectomy. Note: This section does not apply to orthognathic surgery. See the “Oral Surgery” section above for that benefit. Mastectomy Notice A Member who is getting benefits for a mastectomy or for follow-up care for a mastectomy and who chooses breast reconstruction, will also get coverage for: • Reconstruction of the breast on which the mastectomy has been performed; • Surgery and reconstruction of the other breast to give a symmetrical appearance; and • Prostheses and treatment of physical problems of all stages of mastectomy, including lymphedemas. Members will have to pay the same Deductible, Coinsurance, and/or Copayments that normally apply to surgeries in this Plan. Temporomandibular Joint (TMJ) and Craniomandibular Joint Services Benefits are available to treat temporomandibular and craniomandibular disorders. The temporomandibular joint connects the lower jaw to the temporal bone at the side of the head and the craniomandibular joint involves the head and neck muscles. Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services. Covered Services do not include fixed or removable appliances that involve movement or repositioning of the teeth, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures). Therapy Services Physical Medicine Therapy Services Your Plan includes coverage for the therapy services described below. To be a Covered Service, the therapy must improve your level of function within a reasonable period of time. Covered Services include: • Physical therapy – The treatment by physical means to ease pain, restore health, and to avoid disability after an illness, injury, or loss of an arm or a leg. It includes hydrotherapy, heat, physical agents, bio-mechanical and neuro-physiological principles and devices. • Speech therapy and speech-language pathology (SLP) services – Services to identify, assess, and treat speech, language, and swallowing disorders in children and adults. Therapy will develop or treat communication or swallowing skills to correct a speech impairment. • Post-cochlear implant aural therapy – Services to help a person understand the new sounds they hear after getting a cochlear implant. • Occupational therapy – Treatment to restore a physically disabled person’s ability to do activities of daily living, such as walking, eating, drinking, dressing, using the toilet, moving from a wheelchair to a bed, and bathing. It also includes therapy for tasks needed for the person’s job. Occupational therapy does not include recreational or vocational therapies, such as hobbies, arts and crafts. • Chiropractic / Osteopathic / Manipulation therapy – Includes therapy to treat problems of the bones, joints, and the back. The two therapies are similar, but chiropractic therapy focuses on the

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