Noblesville Schools Medical Plan 45 Section 1: Covered Health Care Services Enteral Nutrition Benefits are provided for specialized enteral formulas administered either orally or by tube feeding for certain conditions under the direction of a Physician. Gender Dysphoria Benefits for the treatment of gender dysphoria provided by or under the direction of a Physician. For the purpose of this Benefit, "gender dysphoria" is a disorder characterized by the specific diagnostic criteria classified in the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Habilitative Services For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed plan of treatment to help a person with a medical or behavioral disabling condition to learn or improve skills and functioning for daily living. The Claims Administrator will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a medical or behavioral disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Manipulative Treatment. • Speech therapy. • Post-cochlear implant aural therapy. • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a medical or behavioral disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment.