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 41 expensive equipment of its type that meets your needs. If Blue Cross Blue Shield HMO Blue determines that you chose durable medical equipment that costs more than what you need for your medical condition, benefits will be provided only for those costs that would have been paid for the least expensive equipment that meets your needs. In this case, you must pay all of the health care provider’s charges that are more than the Blue Cross Blue Shield HMO Blue claim payment. Early Intervention Services This health plan covers early intervention services when they are furnished by an early intervention provider for an enrolled child from birth through age two. (This means until the child turns three years old.) This coverage includes medically necessary: physical, speech/language, and occupational therapy; nursing care; and psychological counseling. Emergency Medical Outpatient Services This health plan covers emergency medical care that you receive at an emergency room of a general hospital. (See Part 3.) At the onset of an emergency medical condition that (in your judgment) requires emergency medical care, you should go to the nearest emergency room. If you need help, call 911. Or, call your local emergency phone number. This health plan also covers emergency medical care when the care is furnished for you by a covered provider such as by a hospital outpatient department; or by a community health center; or by a physician; or by a dentist; or by a nurse practitioner. For emergency room visits, you may have to pay a copayment for covered services. If a copayment does apply to your emergency room visit, it is waived if the visit results in your being held for observation or being admitted for inpatient care within 24 hours. Any deductible and/or coinsurance will still apply. (Your Schedule of Benefits describes your cost share amount. Also refer to riders—if there are any—that apply to your coverage in this health plan.) If a covered provider’s office is located at, or professional services are billed by, a hospital, your cost share is the same amount as for an office visit. Gender Affirming Services (Transgender-Related Services) This health plan covers medically necessary gender affirming services for transgender and gender diverse members when gender identity differs from assigned sex at birth. These covered services include (but are not limited to): surgical services (see “Admissions for Inpatient Medical and Surgical Care” and “Surgery as an Outpatient”); behavioral health services (see “Mental Health and Substance Use Treatment”); certain infertility services (see “Infertility Services”); and medical care services (see “Medical Care Outpatient Visits”). Your coverage for these covered services is provided to the same extent as coverage is provided for similar covered services to diagnose and treat a physical condition. To receive coverage for these services, they must be furnished by a covered provider and, in some cases, approved by Blue Cross Blue Shield HMO Blue as outlined in this Subscriber Certificate and in the Blue Cross Blue Shield HMO Blue medical policies for gender affirming services and other related covered services. When a pre- service approval is required, you and your health care provider must receive approval from Blue Cross