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6.2.6. Prescription drugs (Section 2110(a)(6)) X X X 6.2.7. Over-the-counter medications (Section 2110(a)(7))

X 6.2.8. Laboratory and radiological services (Section 2110(a)(8)) X X X 6.2.9. Prenatal care and pre- pregnancy family services and supplies (Section 2110(a)(9)) X X X 6.2.10. Inpatient mental health services, other than services described in 6.2.18., but including services furnished in a state- operated mental hospital and including residential or other 24­ hour therapeutically planned structural services (Section 2110(a)(10)) X X X 6.2.11. Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state- operated mental hospital and including community-based services (Section 2110(a)(11) X X X 6.2.12. Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a)(12)) X X* X 6.2.13. Disposable medical supplies (Section 2110(a)(13)) X X* X 6.2.14. Home and community-based health care services (See instructions) (Section 2110(a)(14))

X 6.2.15. Nursing care services (See instructions) (Section 2110(a)(15))

X 6.2.16. Abortion only if necessary to save the life of the mother or if the X Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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