51 Sterilization Services Benefits include sterilization services and services to reverse a non-elective sterilization that resulted from an illness or injury. Reversals of elective sterilizations are not covered. Sterilizations for women are covered under the “Preventive Care” benefit. Infertility Services Important Note: Although this Plan offers limited coverage of certain infertility services, it does not cover all forms of infertility treatment. Benefits do not include assisted reproductive technologies (ART) or the diagnostic tests and Drugs to support it. Examples of ART include artificial insemination, in-vitro fertilization, zygote intrafallopian transfer (ZIFT), or gamete intrafallopian transfer (GIFT). Covered Services include diagnostic tests to find the cause of infertility, such as diagnostic laparoscopy, endometrial biopsy, and semen analysis. Benefits also include services to treat the underlying medical conditions that cause infertility (e.g., endometriosis, obstructed fallopian tubes, and hormone deficiency). Fertility treatments such as artificial insemination and in-vitro fertilization are not a Covered Service. Mental Health and Substance Use Disorder Services Covered Services include the following: • Inpatient Services in a Hospital or any Facility that must be covered by law. Inpatient benefits include psychotherapy, psychological testing, electroconvulsive therapy, and detoxification. • Residential Treatment in a licensed Residential Treatment Center that offers individualized and intensive treatment and includes: • Observation and assessment by a physician weekly or more often, • Rehabilitation and therapy. • Outpatient Services including office visits, therapy and treatment, Partial Hospitalization/Day Treatment Programs, and Intensive Outpatient Programs and (when available in your area) Intensive In-Home Behavioral Health Services. Virtual Visits as described under the “Virtual Visits (Telemedicine / Telehealth Visits)” section. Examples of Providers from whom you can receive Covered Services include: • Psychiatrist, • Psychologist, • Neuropsychologist, • Licensed clinical social worker (L.C.S.W.), • Mental health clinical nurse specialist, • Licensed marriage and family therapist (L.M.F.T.), • License Mental Health Counselor (L.M.H.C.) or • Any agency licensed to give these services, when they must be covered by law. Occupational Therapy Please see “Therapy Services” later in this section. Office and Home Visits Covered Services include: