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<br />d. <br /> <br />Physical Therapy Services <br /> <br />Short Term services performed or rendered <br />on an outpatient basis at a Participating <br />Hospital or other Approved Health Care <br />Facility or Approved Health Care Program <br />or by a Participating Provider ~hen di- <br />rected and monitored by a participating <br />Primary Care Physician, and authorized in <br />advance by Health Plan. Inpatient physical <br />therapy services are covered in this section <br />under E. 2. a. (2). <br /> <br />e. <br /> <br />Occupational Therapy Services <br /> <br />Short Term services performed or rendered <br />on an outpatient basis at a Participating <br />Hospital or other Approved Health Care <br />Facility or Approved Health Care Program <br />or by a Participating Provider yhen directed <br />and monitored by a Participating Primary Care <br />Physician, and authorized in advance by Health <br />Plan. Inpatient occupational therapy services <br />are covered in this section under E.2.a. (2). <br /> <br />f. <br /> <br />Speech and Hearing Therapy Services <br /> <br />Short Term services performed on an out- <br />patient basis at a Participating Hospital <br />or other Approved Health Care Facility or <br />Approved Health Care Program or by a Par- <br />ticipating Provider ~hen directed and moni- <br />tored by a Participating Primary Care Phy- <br />sician, and authorized in advance by Health <br />Plan. Inpatient speech and hearing therapy <br />services are covered in this section under <br />E. 2. a. (2). <br /> <br />F. <br /> <br />General Exclusions <br /> <br />This Contract does not cover any of the folloYing: <br /> <br />1. <br /> <br />NONE <br /> <br />NONE <br /> <br />NONE <br /> <br />Care for military service connected disabilities for ~hich the Covered <br />Person is legally entitled to services and for which government facilities <br />are reasonably available. <br /> <br />2. <br /> <br />Dental surgery, treatment or care (including treatment of overbite or <br />underbite), or dental X-rays, supplies and appliances (including occlusal <br />splints) and all associated expenses arising out of such dental surgery, <br />treatment or care (including hospitalizations), except for Hospital, <br />Dental and Physician Services and supplies and anesthesiology services <br />recommended by a Participating Primary Care Physician and approved in <br />writing in advance by Health Plan, as are necessary to safeguard the <br />health of a Covered Person because of a specific, nondental physiological <br />impairment. <br /> <br />SB-A2 <br /> <br />-8- <br />