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Ronda Municipal Insurance Trust Medical Master Plan of Beneflts (3) the range of charges for services that will or could be rendered. Hospice care benefits are for reasonable fees incurred for the palliation or management of terminal illness. Benefits shall be payable for the routine home care, and continuous home care subject to a Lifetime Maximum of $6,000**, for a maximum period of six (6) months. Hospice care will only be approved o~ce for a participant. TMJ Benefit - The reasonable fees charged by a hospital, dentists, or physicians for the treatment of temporomandibular joint dysfunction are eligible for benefits up to a Lifetime Maximum of $1,500** for all services related to this condition. Only one $1,500.** lifetime benefit will be provided. Cardiac Rehabilitation Benefit - Service of a state licensed cardiac rehabilitation facility for cardiac rehabilitation on an outpatient basis up to a Lifetime Maximum of $2,000** provided such services are prescribed by a physician and provided under the direct supervision of a physician. A participant who is eligible for this benefit must meet the following criteria: (1) Myocardial Infarction - post myocardial infarction patient may enter the program anytime, at the discretion and referral from physician; (2) Post-op Cardiovascular Surgery - a minimum of three weeks aorta - coronary bypass surgery, or discretion and referral from physician; (3) Adequate control of complications, i.e., angina, congestive heart failure or arrhythmias; (4) Pacemaker patients with any of the above diagnosis andjor decreasing functional capacity. Home Health Care Benefit - The reasonable fees, up to a maximum calendar year benefit of $1,000, incurred for home health services performed by a home health agency resulting from an accident or sickness to a participant while this Plan is in force shall be covered, subject to all Plan provisions, provided the services are performed pursuant to a written plan of treatment prescribed by a physician that is approved in advance by the Trust. Skilled Nursing Facility Benefit - Services and supplies provided under the direction. of a physician, provided the services are performed pursuant to a written plan of treatment prescribed by a physician that is approved in advance by the Trust. Mastectomy Benefit - The reasonable fees for inpatient hospital and physician services associated with the surgical removal of all or a part of the breast if determined medically necessary by a licensed physician, prosthetic devices, and reconstructive surgery incident to the mastectomy, shall be covered, and subject to the following conditions and limitations: (1) Coverage for prosthetic devices and reconstructive surgery shall be limited to the initial prosthetic device and initial reconstructive surgery incident to the mastectomy; (2) If the mastectomy reveals no evidence of malignancy, coverage for prosthetic devices and reconstructive surgery incident to the mastectomy is limited to an initial prosthetic device provided, and to medically necessary reconstructive surgery performed, within two (2) years of the date of the