53 • Inborn errors of metabolism that result in an intellectual disability and that are designated by State of Indiana • Congenital adrenal hyperplasia. • Biotinidase deficiency. • Disorders detected by tandem mass spectrometry or other technologies with the same or greater detection capabilities as tandem mass spectrometry, if the s tate determines that the technology is available for use by a designated laboratory under the applicable state law. • Spinal muscular atrophy • Severe combined immunodeficiency • Physiologic hearing screening examination at the earliest feasible time for the detection of hearing impairments • Pulse oximetry screening examination at the earliest feasible time for the detection of low oxygen levels. • Krabbe disease. • Pompe disease. • Hurler syndrome (MPS1). • Adrenoleukodystrophy (ALD). Contraceptive Benefits Benefits include contraceptive devices such as diaphragms, intra uterine devices (IUDs), and implants. Certain contraceptives are covered under the “Preventive Care” benefit. Please see that section for further details . 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” ben efit. 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 o f 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., end ometriosis, 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.