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') o ) 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. 10.19 Non-participating Provider services. When, in the professional judgment of AvMed's Medical Director, a Member needs covered Medical Services or Hospital Services which require skills or facilities not available from Participating Providers and it is in the best interest of the Mernber to obtain the needed care from a Non-participating Provider, upon authorization by the Medical Director. Payment may not exceed the Maximum Allowable Payment for such covered services rendered by a Non-participating Provider. The amounts requested for payment for non-participating Hospital Services will be reimbursed in accordance with the covered benefits the Member would be entitled to receive in a Participating Hospital. 10.20 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 from the Primary Care Physician. 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: 10.20.01 Hospital stays of at least 48 hours following a normal vaginal delivery, or at least 96 hours following a cesarean section; 10.20.02 The Attending Physician does not need to obtain authorization from AvMed to prescribe a Hospital stay of this length; 10.20.03 AvMed will cover an extended stay, if Medically Necessary; however, your physician or your Hospital must precertifY the extended stay. 10.20.04 Shorter Hospital stays are permitted if the attending health care provider, in consultation with the mother, detennines that to be best course of action. Coverage for maternity care is subject to applicable Co-payments and all other Plan limits and requirements. 10.21 Orthotic appliances. Coverage for orthotic appliances is limited to custom-made leg, arm, back and neck braces when related to a surgical procedure or when used in an attempt to avoid surgery and when necessary to cany out normal activities of daily living, excluding sports activities. Coverage includes the initial purchase, fitting or adjustrnent. Replacernents are covered only when Medically Necessary due to a change in bodily configuration. All other orthotic appliances are not covered. The determination of whether a covered itern will be paid under the DME, orthotics or prosthetics benefits will he based upon its classification as defined by the Centers for Medicare and Medicaid Services. See Schedule of Benefits for any Co-payments or Limitations. See Part XI for Exclusions. ) 10.22 Osteoporosis diagnosis and treatment when Medically Necessary for high-risk individuals, e.g. estrogen-deficient individuals, individuals with vertebral abnormalities, individuals on long-term glucocorticoid (steroid) therapy, individuals with primary hyperparathyroidism, and individuals with a family history of osteoporosis. 10.23 Other health care facility(ies). All routine services of Other Health Care Facilities (see Section 3.35), including physician visits, physiotherapy, diagnostic imaging and laboratory work, are covered for a maximum of 20 days per calendar year when a Member is admitted to such a facility, following discharge from a Hospital, for a condition that cannot be adequately treated with Skilled Home Health Care Services or on an ambulatory basis. 10.24 Outpatient therapeutic services. Covered health services for therapeutic treatments received on an outpatient basis in your home, physician's office, Other Health Care Facility or Hospital, including 26 A V-0100-2009 MP-5319 (10/09)