Part 5 – Covered Services (continued) IMPORTANT: Refer to the Schedule of Benefits for your plan option for the cost share amounts that you must pay for covered services and for the benefit limits that may apply to specific covered services. Once you reach your benefit limit for a specific covered service, no more benefits are provided by Blue Cross Blue Shield HMO Blue for those services or supplies. WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 48 will be provided for these services. For covered acupuncture services, your cost share (such as deductible, copayment, and/or coinsurance) is usually the same cost share that you would pay for other health care services furnished by specialty care providers. A rider may change the information that is shown in your Schedule of Benefits. Be sure to read each rider (if there is any).  Allergy testing. (This includes tests that you need such as PRIST, RAST, and scratch tests.)  Certain intravenous infusions (therapeutic, prophylactic, and diagnostic injections) that are furnished in a physician’s office or in a hospital outpatient setting to administer fluids, substances, or drugs.  Injections. This includes the administration of injections that you need such as allergy shots or other medically necessary injections (except as described above for intravenous infusions). And, except for certain self injectable drugs as described below in this section, this coverage also includes the vaccine, serum, or other covered drug that is furnished during your covered visit. If a copayment would normally apply to your visit, it is waived if the visit is only to administer the injection. (This section does not include injections that are covered as a surgical service such as a nerve block injection or an injection of anesthetic agents. See “Surgery as an Outpatient.”) Coverage for Self Injectable and Certain Other Drugs There are self injectable and certain other prescription drugs used for treating your medical condition that are covered by this health plan only when these drugs are furnished by a covered pharmacy, even when a non-pharmacy health care provider administers the drug for you during a covered visit. For your coverage for these covered drugs, see “Prescription Drugs and Supplies.” No benefits are provided for the cost of these drugs when the drug is furnished by a non-pharmacy health care provider. For a list of these drugs, you can call the Blue Cross Blue Shield HMO Blue customer service office. Or, you can log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org.  Syringes and needles when they are medically necessary for you. If a copayment would normally apply to your visit, it is waived if the visit is only to obtain these items. (Your coverage for these items is provided as a prescription drug benefit when you buy them from a pharmacy.)  Diabetes self-management training and education, including medical nutrition therapy, when it is furnished for you by a certified diabetes health care professional who is a covered provider or who is affiliated with a covered provider.  Pediatric specialty care that is furnished for you by a covered provider who has a recognized expertise in specialty pediatrics.  Non-dental services that are furnished for you by a dentist who is licensed to furnish the specific covered service. This coverage is provided only if the services are covered when they are furnished for you by a physician.  Monitoring and medication management for members taking psychiatric drugs; and/or neuropsychological assessment services. These services may also be furnished by a mental health provider.  Methadone maintenance treatment that is furnished for opioid dependence. For these covered services, this health plan will provide full in-network coverage. The only exception is when you are enrolled in a high deductible health plan with a health savings account. In this case, your deductible