60 Skilled Nursing Facility When you require Inpatient skilled nursing and related services for convalescent and rehabilitative care, Covered Services are available if the Facility is licensed or certified under state law as a Skilled Nursing Facility. Custodial Care is not a Covere d Service. Smoking Cessation Please see Preventive Care section in this booklet. Speech Therapy Please see Therapy Services later in this section. Surgery Your Plan covers surgical services on an Inpatient or outpatient basis, including office surgeries. Covered Services include: Accepted operative and cutting procedures; Other invasive procedures, such as angiogram, arteriogram, amniocentesis, tap or puncture of brain or spine; Endoscopic exams, such as arthroscopy, bronchoscopy, colonoscopy, laparoscopy; Treatment of fractures and dislocations; Anesthesia (including services of a Certified Registered Nurse Anesthetist) and surgical support when Medically Necessary; Medically Necessary pre - operative and post - operative care. 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.

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