Unless specifically listed as a Covered Expense in the Policy or Certificate (or as may be provided by an Amendment Rider), no benefits will be paid for loss or expense caused by, contributed to, or resulting from:
A Pre.existing Condition, defined as: any sickness, injury, disease or physical condition for which medical treatment or advice was received from a Physician within the 5 year period immediately prior to the Insured Person's effective date or which produced symptoms within the 5 year period immediately prior to the Insured Person's effective date; . charges in excess of Usual and Customary Charges; . addiction, alcoholism and codependency; . congenital conditions; circumcision; . cosmetic procedures, except cosmetic surgery required 10 correct an Injury for which benefits are otherwise payable under this plan; . custodial care or rehabilitation care services and supplies; . dental treatment, except for accidental Injury to sound, natural teeth; . elective abortion; . expenses incurred outside of the United States, its possessions, territories or Canada; . hearing examinations, hearing aids, eye exams, glasses or contacts; . Injury caused by, contributed to, or resulting from the use of alcohol, intoxicants, hallucinogenic, illegal drugs, or any drugs or medications that are not taken in the dosage or for the purpose prescribed by the Insured Person's Physician; . Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational Disease Law or Act, or similar legislation; . Injury or Sickness to the extent that benefits are paid by Medicare or any other government law or program (except Medicaid); or medical coverage under any automobile insurance; . mental and behavioral problems; . normal pregnancy, maternity services or supplies; . organ transplants; . participation in a riot or civil disorder; commission of or attempt to commit a felony; . reproductive/infertility services; . routine and/or screening physical examinations, testing, or treatment; . services rendered or supplies purchased from your immediate family; . skydiving, parachuting, hang gliding, glider flying, parasailing, parasailing, bungee jumping, or flight in any kind of aircraft (except while riding as a passenger on a regularly scheduled flight of a commercial airline); . sleep disorders, supplies, treatment, or testing related to sleep disorders; . suicide or attempted suicide while sane or insane; . intentionally self-inflicted Injury; . treatment in a Government hospital, unless there is legal obligation for the Insured Person to pay for such treatment; . treatment or removal or repair of tonsils or adenoids, except for a Medical Emergency; . Sclerotherapy for veins of the extremities; . Services, supplies or treatment of acne, allergy (including testing); . Nasal, sinus surgery, deviated nasal septum, skeletal irregularities of jaws; breast reduction or augmentation; weight management services; . war or any act of war, declared or undeclared; or while in the armed forces of any country.
Detailed information about these and other plan limitations and exclusions are listed in the Policy or Certificate you will receive. The Policy and Certificates issued under it, will be deemed amended to conform to the minimum requirements of the laws of the state in which coverage is issued.