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This plan does not cover nor provide benefits for the following:

  • Services, supplies, or treatment, including any period of hospital confinement, which were not recommended, approved, and certified as necessary and reasonable by a doctor; or expenses non-medical in nature
  • Injury or sickness for which benefits are paid under any worker’s compensation or occupational disease law
  • Treatment provided in a government hospital unless there is a legal obligation to pay such charges in the absence of insurance.
  • Injury or sickness resulting from declared or undeclared war, or any act thereof
  • Services and supplies that do not meet accepted standards of medical or dental practice including, but not limited to, investigational services and supplies and related services
  • Expenses covered by any other valid and collectible medical, health, or accident insurance
  • Charges for failure to keep a scheduled visit or charges for completion of a claim form; or charges for copies of medical records
  • Services and supplies rendered during an inpatient admission, which is primarily related to discipline or other antisocial actions, which are not specifically the result of mental illness
  • Services or supplies in connection with psychological testing or neuropsychological testing
  • Services or supplies used to treat conditions related to autism, hyperkinetic syndrome, learning disabilities, behavioral problems, mental retardation, or senile deterioration, beyond the period necessary to diagnose the condition
  • Routine physicals, preventative medicines, serums, vaccines (including rabies vaccine), or prescription drugs
  • Allergy shots and serum; prescription drugs, longterm medication for chronic conditions, birth control medications, hospital take-home drugs; other drugs and medicines unless hospital billed
  • Therapeutic and diagnostic injections
  • Diagnostic service as part of routine physical examinations or check-ups, pre-marital examination, auditory problems, surveys, case finding, research studies, screening; or similar investigational procedures, studies, or tests; infertility testing
  • Personal hygiene, comfort, and convenience items such as air conditioners, humidifiers, physical fitness equipment, or corrective shoes; or admission kits
  • Procurement or use of special braces, splints, appliances, ambulatory apparatus, specialized equipment, battery or atomically controlled implants, except as specifically provided in this plan
  • Cosmetic surgery, except as the result of an injury occurring while this plan is in force as to the insured person (This exclusion shall also not apply to cosmetic surgery, which is reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection, or other disease of the involved body part, and reconstructive surgery because of congenital disease or anomaly.)
  • Blood plasma, except charges by a hospital for the processing of administration of blood
  • Speech therapy
  • Services and supplies for radial keratotomy
  • Eyeglasses, contact lenses (except when necessary for treatment of cataracts), hearing aids, or prescription or examinations
  • Care of flat feet, supportive devices for the foot (orthotics); care of corns, bunions, or calluses; care of toenails and fallen arches; weak feet or chronic foot strain except if medically necessary due to diabetes or circulatory problems
  • Expenses incurred for charges made by a doctor or physiotherapist if such person is related to the insured person or ordinarily resides with the insured person requiring treatment
  • Expenses incurred as the result of dental treatment, except as provided in the accidental dental benefit
  • Expenses incurred for treatment of temporomandibular joint dysfunction (TMJ) and associated myofacial pain
  • Injury resulting from the practice or play of intercollegiate sports
  • Elective sterilization
  • Elective abortions
  • For human organ transplant other than cornea, kidney, bone marrow, heart valve, muscularskeletal and parathyroid human organ or tissue transplant
  • Procurement or use of prosthetic devices, special appliances and surgical implants that are for cosmetic purposes, the comfort and convenience of this insured person, or unrelated to the treatment of disease or injury
  • Services or supplies provided for treatment of obesity and/or weight control; nutrition programs; surgery for removal of excess skin or fat, and treatment of eating disorders such as bulimia and anorexia, except as specifically provided in the policy (Exception: Benefits will be provided for the treatment of dehydration and electrolytes imbalance associated with eating disorders.)
  • Services and supplies related to the treatment or use of nicotine from tobacco or other sources
  • Charges for self-administered service, self care, selfhelp training, biofeedback, and related diagnostic testing
  • Elective treatment or elective surgery, except as specifically provided
  • Breast augmentation or reduction