STUDENT AND DEPENDENT MEDICAL PLANS

Exclusions

1. Expenses incurred in connection with routine exams or other care, treatment, services and supplies which are not medically necessary for the treatment of a Disability, including those which are not consistent with the diagnosed Sickness or Injury. This exclusion is waived for routine mammograms, as specifically included (page 4 of brochure).
2. Expenses incurred for or in connection with diagnosis, care and treatment of a mental/nervous condition or alcohol/substance abuse, except as specifically provided.
3. Care, treatment, services or supplies rendered in connection with cosmetic procedures, unless needed because of a covered Injury or Sickness.
4. Expenses incurred in connection with Injuries resulting from an accident involving a motor vehicle, to the extent benefits are payable under any other insurance policy or plan of benefits, unless those benefits are paid only as a result of litigation.
5. Expenses in connection with treatment directly to or on the teeth or gums, except as specifically included and when needed due to Injury to sound, natural teeth.
6. Hearing aids or examinations for the prescription and fitting.
7. Expenses incurred in connection with Injury or Sickness which arises out of or in the course of any occupation or employment, for which the covered student is entitled to benefits under any Workers' Compensation or similar law.
8. Forms of self-care or self-help training and any related diagnostic testing.
9. Care which is not recommended and approved by a Physician.
10. Organ or tissue transplant procedures, unless pre-approved by the Plan.
11. Treatment of obesity.
12. Injuries resulting from air travel except when traveling as a passenger on a regularly scheduled commercial airflight.
13. Custodial Care: for example, help in walking, bathing, preparing meals, and other activities of daily living.
14. Expenses incurred, to the extent that they exceed the usual, customary and reasonable charge.
15. Services or supplies which are experimental or investigational in nature.
16. Injury sustained or Sickness contracted as a result of committing or attempting to commit a felony, or being engaged in an illegal occupation.
17. Services rendered by a person who is an immediate relative of or who ordinarily resides with the covered student requiring treatment.
18. Services or supplies rendered or furnished to a covered student while in the active military service of any country.
19. Expenses incurred when no coverage is in force for the person incurring charges.
20. Expenses which the covered student has no legal obligation to pay or for which no charge would be made if he had no coverage.
21. Travel, even though prescribed by a Physician.
22. Expenses for or in connection with procedures intended solely to increase or enhance fertility; artificial insemination, in-vitro fertilization or similar procedures; reversals of previous sterilization procedures; transsexual surgery; or surrogacy.
23. Services or supplies rendered or furnished in a Military or Veterans Administration Hospital, unless rendered in connection with a Disability which is not in any way related to the covered student's military service.
24. Injury or Sickness caused by war or any act of war, whether declared or undeclared.
25. Expenses in connection with treatment of Injuries received in practice for or participation in intercollegiate sports.