Ins 8.72(2)(2) Hospital care, including all of the following: Ins 8.72(2)(a)(a) Semi-private room, board and ancillary services and supplies that are generally provided to hospital inpatients. Ins 8.72(2)(b)(b) Confinement in an intensive care or coronary care unit of a hospital. Ins 8.72(2)(d)(d) Medical care and treatment provided in a hospital emergency room. Ins 8.72(4)(4) Outpatient x-ray, laboratory and other diagnostic tests. Ins 8.72(6)(6) Services provided by a home health agency licensed under s. 50.49, Stats. Ins 8.72(8)(8) Local ground licensed ambulance services. Ins 8.72(10)(10) Rental and purchase of durable medical equipment and supplies. Ins 8.72(12)(12) Reconstructive surgery which is either of the following: Ins 8.72(12)(a)(a) Incidental to or following surgery necessitated by illness or injury. Ins 8.72(12)(b)(b) Caused by a congenital disease or anomaly of a covered dependent child which results in a functional defect. Ins 8.72(14)(14) Maternity services including all of the following: Ins 8.72(14)(b)(b) Delivery services normally associated with a vaginal or caesarean section delivery. Ins 8.72(14)(c)(c) Routine nursery care from the moment of birth until the infant is discharged from the hospital. Ins 8.72(16)(16) Inpatient, outpatient and transitional treatment for nervous and mental disorders and alcoholism and other drug abuse, subject to s. Ins 8.75 (3). Ins 8.72(17)(17) Preventive services appropriate to the age and sex of the covered person including all of the following: Ins 8.72(17)(a)(a) Routine physical examinations and health screening tests. Ins 8.72(17)(b)(b) Immunizations for poliomyelitis, diphtheria, pertussis, typhoid, measles, mumps and rubella.