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I I' I I ) q \ , 9.17 Mammograms arc covered in accordance with Florida Statutes. One baseline mammogram is covered for female Members between the ages of 35 and 39. A mammogram is available every two years for female Members between the ages of 40 and 49 and a mammogram is available every year for female Members aged 50 and older. 9.18 In addition, one or more mammograms a year are available when based upon a physician's recommendation for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister, or daughter who has had breast cancer, or because a woman has not given birth before the age of 30. l\1astectomy surgery when performed for breast cancer. Coverage for post-mastectomy reconstructive surgery shall include: 9.18.01 Reconstruction of the breast on which the mastectomy has been pcrformed; 9.18.02 Surgery and reconstruction on the other breast to produce a symmetrical appearance; and 9.17.01 Prostheses and physical complications during all stages of mastectomy including Iymphedemas. The length of stay will not be less than that determined by the Attending Physician to be Medically Necessary in accordance with prevailing medical standards and after consultation with the covered patient. The Attending Physician, after consultation with the covered patient, may choose that the outpatient care be provided at the most medically appropriate setting, which may include the hospital, treating physician's office, outpatient center, or home of the covered patient. Coverage is subject to any applicable Co-payment or Co-insurance and will require pre- authorization of services as applicable to other surgical procedures or hospitalizations under the Plan. 9.19 Newborn care. All services applicable for children under this Contract are covered for an enrolled newborn child of the Subscriber or the enrolled newborn child ofa covered Dependent of the Snbscriber or the newborn adopted child of the Subscriber (as described in Subsection 3.02.05), from the moment of birth, including the Medically Necessary care or treatment of medically diagnosed congenital defects, birth abnormalities or prematurity, and transportation costs to the nearest facility appropriately staffed and equipped to treat the newborn's condition, when such transportation is Medically Necessary. Circumcisions are provided for up to one year from date of birth. 9.18.03 9.18.04 9.18.05 9.20 Obstetrical and gynecological care. An annual gynecological examination and Medically Necessary follow-up care detected at that visit are available without the need for a prior referral. Obstetrical care benefits as specified herein are covered and include Hospital care, anesthesia, diagnostic imaging, and laboratory services for conditions related to pregnancy unless such pregnancy is the result of a preplanned adoption arrangement, more commonly known as surrogacy. The length of maternity stay in a Hospital will be that determined to be Medically Necessary in compliance with Florida law and in accordance with the Newborns' and Mothers' Health Protection Act, as follows: 9.20.01 Hospital stays of at least 48 hours following a normal vaginal delivery, or at least 96 hours following a cesarean section; The Attending Physician does not need to obtain authorization from AvMed to prescribe a Hospital stay of this length; AvMed will cover an extended stay, if Medically Necessary; however, your physician or your Hospital must precertity the extended stay; 9.20.02 9.20.03 28 A V-CHOICE-2009 MP-5320 (10/09)