52 • Interpersonal and Domestic Violence Screening and Counseling: Adolescent and adult women are cove red for screening and counseling for interpersonal and domestic violence. The Plan covers the above services in accordance with applicable federal guidelines. Covered services received from an in - network provider will be paid at 100%. Covered services rece ived from an out - of - network provider are subject to the out - of - network deductible and Payment Percentage. Routine Newborn Care The charges that are listed below for routine care of a newborn at the time of delivery are covered medical benefits under the terms of the Plan, and are payable on the same basis as an illness. • Charges of an Acute Care Hospital for routine nursery care furnished to a newborn well baby at the time of birth. • Charges of a physician or Allied Health Professional for one routine exami nation of a newborn well baby performed each day before the child is released from nursery care. Second Surgical Opinion Charges for a second surgical opinion are paid on the same basis as charges for an illness. Charges for a third surgical opinion also w ill be covered if the first and second opinions do not confirm that the surgery is medically necessary. Short - Term Rehabilitative Therapy Short - term rehabilitative therapy that is part of a rehabilitation program, including physical, speech, occupational, cognitive, osteopathic manipulative, cardiac rehabilitation, and pulmonary rehabilitation therapy is covered subject to the following limitations: • To be covered all therapy services must be restorative in nature. Restorative therapy services are services t hat are designed to restore levels of function that had previously existed but that have been lost as a result of injury or illness. Restorative therapy services do not include therapy designed to acquire levels of function that had not been previously ach ieved prior to the injury or illness. • Services are not covered if they are custodial, training, educational or developmental in nature. • Occupational therapy is provided only for purposes of enabling persons to perform the activities of daily living after a n illness, injury, or sickness. Short - term rehabilitative therapy services that are not covered include, but are not limited to: • Sensory integration therapy, group therapy; treatment of dyslexia, behavior modification or myofunctional therapy for dysfluenc y, such as stuttering or other involuntary acted conditions without evidence of an underlying medical condition or neurological disorder; • Treatment for functional articulation disorder such as correction of tongue thrust, lisp, verbal apraxia or swallowing dysfunction that is not based on an underlying diagnosed medical condition or injury ; and • Maintenance or preventive treatment consisting of routine, long term or non - medically necessary care provided to prevent recurrence, or to maintain the current statu s of the individual. If multiple outpatient services are provided on the same day, the visits will be treated as a single visit. Chiropractic treatment is not covered under the rehabilitative therapy benefits. See the section on Chiropractic Care for info rmation about Chiropractic treatment and limits. The Plan does not cover physical, speech, occupational, cognitive, osteopathic manipulative, cardiac rehabilitation, or pulmonary rehabilitation therapy except for the short - term treatment of an acute