All Services And Benefits For Care And Conditions Within Each Of The Following Classifications Will Be
Excluded From Coverage Under This Health Plan.

• Acupuncture
• Addictions To Food, Caffeine And Tobacco
• Art Therapy
• Behavior Modification And Conduct Disorders
• Behavioral Health Treatments – Treatment Sessions Provided By Telephone Or Computer Internet
• Cosmetic Procedures
• Court-Ordered Care
• Custodial Or Domiciliary Care
• Dental Services And Dental Appliances
• Disabilities Connected To Military Services
• Elective Or Voluntary Enhancement Procedures
• Experimental Or Investigational Procedures
• Eye Surgery For Improving Refraction
• Gambling Addiction
• Hearing Aids
• Infertility Services
• Institutional Services And Supplies
• Learning Disabilities
• Lost Or Stolen Medications
• Marriage Counseling
• Medicare Benefits For Medicare Beneficiaries
• Methadone Treatment Or Maintenance
• Non-Licensed Professionals
• Non-Organic Therapies
• Nursing-Private Duty
• Occupational Injuries
• Oral Surgery
• Organic Therapies
• Out-Of-Area Students And Dependents
• Prescription Drugs
• Sex Therapy
• Sex Transformations
• Sexual Dysfunction
• Spiritual Counseling
• Vision Materials Limitations
• Biofeedback
• Circumcision
• Diabetic Education Programs
• Elemental Enteral Formula
• Foot Orthotics
• Genetic Testing
• Immunizations
• Obesity Treatment
• Organ Donor - Public Facility Care
• Routine Health Evaluations
• Skilled Nursing Care
• Surrogate Mothers
• Temporomandibular Joint Syndrome (Tmj)
• Transplants