66 Family Planning Charges for family planning related services including medical history, physical exam, related laboratory tests, medical supervision in accordance with generally accepted medical practices, counseling on contraception, implanted or injected contraceptives, medical services connected with surgical therapies including tubal ligation or vasectomy, are covered medical benefits (oral contraceptives are covered under the Prescription Drug Coverage) under the terms of the Plan. Other limitations that apply to preventive services will also apply to family planning services. Women’s Preventive Care Routine annual gynecological exam, annual Papanicolaou (PAP) screening, and routine mammography screening are provided by the Plan as specified above. The Plan also provides coverage for female participants as follows: • Gestational Diabetes Screening: Covered for women who are 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. • HPV DNA Testing : Covered every three (3) years for women age 30 and over, regardless of Pap smear results. • STI Counseling : Covered annually for sexually active women. An STI is a sexually transmitted infection. • HIV Screening and Counseling: Covered annually for sexually active women. • Contraception and Contraceptive Counseling: All FDA approved contraceptive methods, sterilization procedures, patient education and counseling. Oral contraceptives are covered under the Prescription Drug Coverage • Breastfeeding Support, Supplies, and Counseling : Pregnant and postpartum women are covered for lactation support and counseling, and breastfeeding equipment. Breastfeeding equipment is limited to the rental of one breast pump per birth as ordered or prescribed by a physician and related supplies. • Interpersonal and Domestic Violence Screening and Counseling: Adolescent and adult women are covered 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 are not subject to the deductible and will be paid at 100%. Covered services received from an out-of-network provider are not subject to the deductible, but the out-of- network Payment Percentage will apply. 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 for one routine examination of a newborn well baby performed each day before the child is released from nursery care.