2026 CODAC Benefit Summaries and Carrier Flyers

20. Contraceptives and Counseling: All Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling.

The following contraceptives will be processed under the medical Plan:

• Contraceptive mobile app subscription (e.g., Natural Cycles). • Contraceptive injections (such as Depo-Provera) and their administration regardless of purpose. • Contraceptive devices such as IUDs and implants, including their insertion and removal regardless of purpose.

21. Cornea Transplants are payable at the percentage listed under All Other Covered Expenses on the Schedule of Benefits.

22. Dental Services include:

• The care and treatment of natural teeth and gums if an Injury is sustained in an Accident (other than one occurring while eating or chewing), or for treatment of cleft palate, including implants. Treatment must be completed within 3 months of the accident unless extenuating circumstances exist except when medical and/or dental conditions preclude completion of treatment within this time period. • Inpatient or Outpatient Hospital charges, including professional services for X-rays, laboratory services, and anesthesia while in the Hospital, if necessary due to the patient’s age of 5 years or under, due to intellectual disabilities, or because an individual has medical conditions that may cause undue medical risk. • Removal of all teeth at an Inpatient or Outpatient Hospital or dentist’s office if removal of the teeth is part of standard medical treatment that is required before the Covered Person can undergo radiation therapy for a covered medical condition. 24. Dialysis : Dialysis services, diagnostic testing, laboratory tests, equipment and supplies are a Covered Expense under the Plan only to the extent they are Medically Necessary and only insofar as their cost does not exceed the Reasonable and Allowable Amount. Dialysis services, diagnostic testing, laboratory tests, equipment, and supplies are those services and items used in the dialysis treatment for acute renal failure or chronic irreversible renal insufficiency (treatment of anemia and other diagnoses related to renal failure). This also includes injectable and intravenous medication including, but not limited to, Heparin, Epogen, Procrit, and other medications administered directly before, during or after a dialysis procedure. Dialysis procedures are for the removal of waste materials from the body, including hemodialysis and peritoneal dialysis regardless of whether they are provided on an Inpatient or Outpatient basis. • The equipment must meet the definition of Durable Medical Equipment in the Glossary of Terms. Examples include, but are not limited to, crutches, wheelchairs, Hospital-type beds, and oxygen equipment. • The equipment must be prescribed by a Physician. • The equipment will be provided on a rental basis when available; however, such equipment may be purchased at the Plan's option. Any amount paid to rent the equipment will be applied toward the purchase price. In no case will the rental cost of Durable Medical Equipment exceed the purchase price of the item. • The Plan will pay benefits for only ONE of the following: a manual wheelchair, motorized wheelchair, or motorized scooter, unless necessary due to the growth of the person or if changes to the person's medical condition require a different product, as determined by the Plan. 23. Diabetes Treatment: Charges Incurred for the treatment of diabetes and diabetic self-management education programs, diabetic shoes, and nutritional counseling. 25. Durable Medical Equipment, subject to all of the following:

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