61 • 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 tee th (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 joints of the spine and the nervous system, while osteopathic therapy also focuses on the joints and surrounding muscles, tendons and ligaments. Other Therapy Services Benefits are also available for: • Cardiac Rehabilitation – Medical evaluation, training, supervised exercise, and psychosocial support to care for you after a cardiac event (heart problem). Benefits do not include home programs, on - going conditioning, or maintenance care. • Chemotherapy – Treatment of an illness by chemical or biological antineoplastic agents. See the section “Prescription Drugs Administered by a Medical Provider” for more details. • Dialysis – Services for acute renal failure and chronic (end - stage) renal disease, including hemodialysis, home intermittent peritoneal dialysis (IPD), home continuous cycling peritoneal dialysis (CCPD), and home continuous ambulatory peritoneal dialysis (CAPD). Cove red Services include dialysis treatments in an outpatient dialysis Facility. Covered Services also include home dialysis and
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