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SERVICE SCOPE OF BENEFIT (ANNUAL) Including but not limited to: In Lieu of Service All services as provided in § 2.9(C) of this Part can be utilized as an in Lieu of Service if alternative service or setting is a medically appropriate and cost-effective substitute for the covered service or setting. Value Add Services Services/equipment which are not in the State Plan but are cost effective, improve health and clinically appropriate. Neonatal Intensive Care Unit (NICU) Covered under the following circumstances: Admitted to Women and Infants (W&I) from home after discharge, admitted to W&I NICU from home after discharge from W&I Normal Newborn Nursery, Admission to non-W&I level 2 Nursery, Admission to W&I NICU from home following delivery at and discharge from non- W&I facility or discharge from non-W&I NICU with admission to W&I for continued care. D. Extended family planning services – The extended family planning group benefit package includes: 1. Gynecological Services. Limited to no more than four (4) office visits annually – One (1) comprehensive gynecological annual exam and up to three (3) additional family planning method related office visits if indicated. 2. Laboratory. Includes annual Pap smear; STD screening if indicated; anemia testing; dipstick urinalysis and urine culture if indicated; pregnancy testing. 3. Procedures. Limited to the following office/clinic/outpatient procedures if indicated tubal ligation; treatment for genital warts; Norplant insertion and removal; IUD insertion and removal; incision and drainage of a Bartholin's gland cyst or abscess. 4. Includes generic-first prescriptions and non-prescription family planning methods (Limited to twelve (12) thirty (30) day supplies per year) when prescribed by a health plan physician or APP.