Limitations and Exclusions
Benefits are not paid for services that are not medically necessary. In addition, benefits are limited or excluded for the following:
Abortion. Addiction. Breast reduction or enlargement . Complications of excluded services or procedures. Cosmetic, reconstructive, or plastic surgery* . Custodial care. Dental care. Eating disorder. Eyeglasses, contact lenses, and the charges to prescribe or fit them. Expenses not covered under the policy. Treatment by family member. Foot care. Any type of care received outside the United States. Free services . Gender change or modification. Growth disorders. Hearing aids or surgery. Human organ, bone marrow, and tissue transplants* . Total or partial hysterectomy in first six months of coverage. Expenses incurred as a result of participation in illegal activities. Expenses incurred as a result of using illegal narcotics, alcohol, or non-prescribed controlled substances. Infertility treatment. Treatment that is investigational, experimental, and/or for research . Learning disabilities (ADD or hyperactivity) . Outpatient medication.' Mental or nervous disorders* . Non-medical expenses. Normal pregnancy and childbirth. Expenses incurred as a result of participation in sporting event for compensation. Pre-existing conditions. Preventive services . Sterilization or reversal of sterilizations. Expenses incurred as a result of self-harm. Manual or mechanical adjustment or manipulations* . Sleep disorders. Substance abuse . Expenses incurred as a result of participation in rodeo contest, sky diving, scuba diving, hang- or ultra-light gliding, racing with boats, aircraft, motorcycles, or all-terrain vehicles. Supplies of a common household use . Temporomandibular joint disorder(TMJ) . Myringotomy, tympanotomy, herniorraphy, tonsils or adenoids or any sinus surgery performed in the first six months of coverage* . Travel or lodging expenses. Radial keratotomy, keratomileusis, excimer laser photo refractive keratectomy, and treatment of eye refraction defects or to improve visual acuity. Expenses incurred as a result of war or riot. Weight control expenses . Well-baby care. Expenses covered by worker's compensation.