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pregnancy is the result of an act of rape or incest (Section 2110(a)(16) 6.2.17. Dental services (Section 2110(a)(17)) X X*** 6.2.18. Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18)) X X* X 6.2.19. Outpatient substance abuse treatment services (Section 2110(a)(19)) X X* X 6.2.20. Case management services (Section 2110(a)(20)) 6.2.21. Care coordination services (Section 2110(a)(21)) 6.2.22. Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22)) X X* X 6.2.23. Hospice care (Section 2110(a)(23)) X X X 6.2.24. Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services. (See instructions) (Section 2110(a)(24))

X* 6.2.25. Premiums for private health care insurance coverage (Section 2110(a)(25)) 6.2.26. Medical transportation (Section 2110(a)(26)) X X* X 6.2.27. Enabling services (such as transportation, translation, and outreach services (See instructions) (Section 2110(a)(27))

X* 6.2.28. Any other health care services or items specified by the Secretary and not included under this section (Section 2110(a)(28)) 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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