Benefits include only services for a "therapeutic abortion," which is an abortion performed to save the life of the mother. Public funding is not prohibited when an abortion is performed to save the life of the mother.

Limit: 3000.0 Dollars per Episode

Treatment must begin within 12 months of the injury

Chiropractic visits beyond 26 per benefit period require Prior Authorization

Covered Services include dialysis treatments in an outpatient dialysis, or home dialysis and training for you and the person who will help you with home self- dialysis

Exclusions: Non-Medically Necessary enhancements to standard equipment and devices.

Limit: 1.0 Item(s) per Year

Covered lenses and frames each available at limit of one per year

Limit: 20.0 Visit(s) per Benefit Period

Exclusions: ABA for autism only covered through age 18.

Habilitative services definition: "help you keep, learn or improve skills and functioning for daily living."

Exclusions: Not covered for adults aged 19 and older

Benefits include hearing aids provided to a newborn for initial amplification following a newborn hearing screening. Limited to 1 hearing aid per ear, every 4 years, for children through age 18.

Limit: 100.0 Visit(s) per Benefit Period

To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis

Exclusions: Fertility treatments such as artificial insemination and in-vitro fertilization are not a Covered Service.

Covered Services include diagnostic tests to find the cause of infertility and services to treat the underlying medical conditions that cause infertility

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Limit: 20.0 Visit(s) per Benefit Period

To be Covered Services, rehabilitation services must involve goals you can reach in a reasonable period of time. Benefits will end when treatment is no longer Medically Necessary and you stop progressing toward those goals.

Cost share applies to both in-person and telemedicine services.

Limit: 82.0 Visit(s) per Benefit Period

Exclusions: Private Duty Nursing Services excluded if given in a Hospital or Skilled Nursing Facility.

Private duty nursing services are a Covered Service only when given as part of the "Home Care Services" benefit. Private Duty Lifetime Maximum: 164 visits In- and Out-of-Network combined.

Benefits include the purchase, fitting, adjustments, repairs and replacements

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.

Limit: 20.0 Visit(s) per Benefit Period

20 visit limit each for PT and OT.

Unlimited visits for speech therapy.

Limit: 1.0 Exam(s) per Benefit Period

Exclusions: Coverage is only available if Medically Necessary

Coverage is available if Medically Necessary.

Limit: 150.0 Days per Benefit Period

Limit is for in-and out-of-network combined and includes rehab and outpatient day rehab.

Cost share applies to both in-person and telemedicine services.

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: Covered Services do not include fixed or removable appliances that involve movement or repositioning of the teeth, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures)

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services.

Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full.