43 Coverage is provided for both inpatient and outpatient Mental Health Services, including, but not limited to, treatment of conditions such as anxiety or depression which interfere with daily functioning; emotional adjustment or concerns related to chronic conditions, such as psychosis or depres sion; emotional reactions associated with marital problems or divorce; child/adolescent problems of conduct or poor impulse control; affective disorders; suicidal or homicidal threats or acts; eating disorders; or acute exacerbation of chronic mental healt h conditions (crisis intervention and relapse prevention), and outpatient testing and assessment. Covered services also may include inpatient care at a Mental Health Residential Treatment Center, Partial Hospitalization, and Intensi ve Outpatient Therapy pr ograms. The Plan does not cover diagnoses such as learning, behavioral and developmental disorders under this benefit or under any other benefit. Neither does the Plan cover therapies such as art, music, drama, physical, speech, recreational, occupational, and adjunctive under thi s benefit or any other benefit. Nutritional Evaluation Charges for nutritional evaluation and counseling are covered medical charges under the terms of the Plan when ordered by a physician or Allied Health Professional, but only when diet is part of the medical management of a diagnosed and documented organic illness. Organ Transplant Charges in connection with medically necessary, non - experimental, human organ and tissue transplant, including services that include solid organ and bone marrow/stem cell procedures, are covered medical charges under the terms of the Plan as provided below: Transplant services include the covered recipient’s medical, surgical and Hospital services; inpatient immunosuppressive medications; and costs for organ or bone marrow/stem cell procurement. Transplant services are cov ered only if they are required to perform any of the following human to human organ or tissue transplants; allogeneic bone marrow/stem cell, autologous bone marrow/stem cell, cornea, heart, heart/lung, kidney, kidney/pancreas, liver, lung, pancreas or inte stinal which includes small bowel, liver or multivi sceral. All covered transplant services that are provided by non - participating providers will be payable at the out - of - network lev el under the terms of the Plan. Coverage for organ procurement costs are li mited to costs directly related to the procurement of an organ from a cadaver or a live donor. Organ procurement costs shall consist of surgery necessary for organ removal and organ transportation. Charges for transportation and hospitalization of a live d onor are covered only if both the donor and the recipient are covered Plan participants. Donor compatibility testing undertaken before procurement, and costs related to the search for, and identification of, a bone marrow or stem cell donor for an allogene ic transplant are also covered, but only if both the potential donor and the recipient are covered Plan participants. Podiatry Care The charges for podiatry care that are covered medical charges include medically necessary services of a podiatrist acting within the scope of his or her license. For example, podiatry care includes charges for the diagnosis and treatment of chronic foot pain; instability or imbalance of the feet; foot deformities; and toenail infections. Podiatry care also includes the charge for custom molded orthotics, but does not include the charge for shoes or pre - fabricated shoe inserts. The podiatry care benefit does not cover routine foot care such as paring and removal of corns and calluses, or trimming of toenails. However, services associated with foot care for diabetes and peripheral vascular disease are covered medical charges when medically necessary under the terms of the Plan. Podiatry care is limited to 30 - days maximum per calendar year, regardless of the service provider. Bene fits for medically necessary surgery are not subject to the 30 - days limitation, but are payable on the same basis as benefits for any other covered surgery.
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