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 36  Emergency admission services. These services must be furnished for you by a physician; or by a nurse practitioner. This means that a complete history and physical exam is performed before you are admitted as an inpatient for emergency medical care and your treatment is taken over immediately by another physician.  Pediatric specialty care. This is care that is furnished for you by a covered provider who has a recognized expertise in specialty pediatrics.  Second surgical opinions. These services must be furnished for you by a physician. This includes a third opinion when the second opinion differs from the first. Rehabilitation Hospital Admissions You and your health care provider must receive approval from Blue Cross Blue Shield HMO Blue as outlined in this Subscriber Certificate before you enter a rehabilitation hospital for inpatient care. Blue Cross Blue Shield HMO Blue will let you and your health care provider know when your coverage is approved. (See Part 4.) When inpatient care is approved by Blue Cross Blue Shield HMO Blue, this health plan provides coverage only until you reach your benefit limit. The Schedule of Benefits for your plan option describes the benefit limit that applies for these covered services. (Also refer to riders—if there are any—that apply to your coverage in this health plan.) Once you reach this benefit limit, no more benefits will be provided for these services. This is the case whether or not the care is medically necessary. (Whether or not your plan option has a benefit limit for these services, coverage is provided only for those services that are determined by Blue Cross Blue Shield HMO Blue to be medically necessary for you.) This coverage includes: semiprivate room and board and special services furnished for you by the hospital; and medical care furnished for you by a physician or by a nurse practitioner. Skilled Nursing Facility Admissions You and your health care provider must receive approval from Blue Cross Blue Shield HMO Blue as outlined in this Subscriber Certificate before you enter a skilled nursing facility for inpatient care. Blue Cross Blue Shield HMO Blue will let you and your health care provider know when your coverage is approved. (See Part 4.) When inpatient care is approved by Blue Cross Blue Shield HMO Blue, this health plan provides coverage only until you reach your benefit limit. The Schedule of Benefits for your plan option describes the benefit limit that applies for these covered services. (Also refer to riders—if there are any—that apply to your coverage in this health plan.) Once you reach this benefit limit, no more benefits will be provided for these services. This is the case whether or not the care is medically necessary. (Whether or not your plan option has a benefit limit for these services, coverage is provided only for those services that are determined by Blue Cross Blue Shield HMO Blue to be medically necessary for you.) This coverage includes: semiprivate room and board and special services furnished for you by the facility; and medical care furnished for you by a physician or by a nurse practitioner. Ambulance Services This health plan covers ambulance transport. This coverage includes:  Emergency Ambulance. This includes an ambulance that takes you to an emergency medical facility for emergency medical care. For example, this may be an ambulance that takes you from an accident scene to the hospital. Or, it may take you from your home to a hospital due to a heart attack. This also