60 • that has persisted for at least five (5) years; and • for which nonsurgical treatment supervised by a Physician has been unsuccessful for at least six (6) consecutive months. The Plan cannot cover services for the surgical treatment of morbid obesity for a Member younger than 21 years of age unless two (2) Physicians licensed under Indiana Code 25 - 22.5 ( one who holds the degree of doctor of medicine or doctor of osteopathy or its equivalent and who holds a valid unlimited license to practice medicine or osteopathic medicine in Indiana) determine that the surgery is necessary to: • save the life of the Member; or • restore the Member's ability to maintain a major life activity (self - care, receptive and expressive language, learning, mobility, self - direction, capacity for independent living, or economic self - sufficiency); and each Physician documents in the Member's medical record the reason for the Physician's determination. “Morbid obesity” means: • a body mass index of at least thirty - five (35) kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or • a body mass index of at least forty (40) kilograms per meter squared without comorbidity. For purposes of this subsection, body mass index equals weight in kilograms divided by height in meters squared. Oral Surgery Important Note: Although this Plan covers certain oral surgeries, many oral surgeries are not covered. Benefits are limited to certain oral surgeries including: • Treatment of medically diagnosed cleft lip, cleft palate, or ectodermal dysplasia; • Orthognathic surgery for a physical abnormality that prevents normal function of the upper and/or lower jaw and is Medically Necessary to attain functional capacity of the affected part. • Oral / surgical correction of accidental injuries as indicated in the “Dental Services (All Members/All Ages)” section. • Treatment of non - dental lesions, such as removal of tumors and biopsies. • Incision and drainage of infection of soft tissue not including odontogenic cysts or abscesses. • Removal of impacted wisdom teeth. 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 rest ore 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: