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 61 card. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. The provisions described in this paragraph do not apply to you if your health plan is a grandfathered health plan under the Affordable Care Act. No benefits are provided for exams that are needed: to take part in school, camp, and sports activities; or by employers or third parties. The only exception to this is when these exams are furnished as a covered routine exam. Annual Mental Health Wellness Exams This health plan covers mental health wellness exams for at least one exam for each member in each calendar year. This coverage may be furnished by a covered provider, including mental health providers. As required by state law, this health plan provides full coverage for these covered services. You pay nothing for in-network and out-of-network benefits. (Any deductible, copayment, and/or coinsurance that you would normally pay will not apply.) A mental health wellness exam is a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The exam may include: observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports, and discussion of potential options for medication; and age-appropriate screenings or observations to understand a covered member’s mental health history, personal history, and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews, and questions. Women’s Preventive Health Services All female members have coverage for women’s preventive health services as recommended by the U.S. Department of Health and Human Services. These types of preventive health services include: yearly well-woman visits; domestic violence screening; human papillomavirus (HPV) DNA testing; screening for human immunodeficiency virus (HIV) infection; birth control methods and counseling (see “Family Planning”); screening for gestational diabetes; and breastfeeding support and breast pumps (see “Durable Medical Equipment”). For a complete description of these covered preventive health services, you can call the Blue Cross Blue Shield HMO Blue customer service office at the toll free phone number shown on your ID card. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. Your coverage for these preventive health services is subject to all of the provisions and requirements of this health plan. See other sections of your Subscriber Certificate to understand the provisions related to your coverage for prenatal care, routine GYN exams, family planning, and pharmacy benefits for birth control drugs and devices when you have prescription drug coverage under this health plan. Routine Gynecological (GYN) Exams This health plan covers one routine GYN exam for each member in each calendar year when it is furnished by a covered provider. This may include (but is not limited to): a physician; or a nurse practitioner; or a nurse midwife. This coverage also includes one routine Pap smear test for each member in each calendar year.