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<br />29. <br /> <br />30. <br />31. <br /> <br />32. <br />33. <br />34. <br /> <br />14. <br /> <br />c. The U.S. Department of Public Health, <br />d. The National Institute of Health; <br />Charges related to cosmetic surgery except: <br />a. To repair disfigurement because of an accidental bodily injury which occurs while covered under the plan, or <br />b. For reconstructive surgery because of mastectomy which is perfonned within 12 months of the mastectomy <br />because of malignancy and while covered under the plan, or <br />c. For treatment of a congenital anomaly in a child born to the insured while covered under the Plan; <br />Unless specifically provided for in the plan, dental care or oral surgery except for closed or open reduction of ftactures <br />or dislocation of the jaw; <br />Unless specifically provided in the Plan, charges for treatment of Mental Illness; <br />Unless specifically provided in the Plan, charges for treatment of Alcohol or Drug Abuse; <br />Unless specifically provided in the Plan, charges for refractions, eyeglasses or their fitting; <br />Hearing aids or their fitting; <br />Charges in connection with obesity, weight reduction, or dietetic control except for morbid obesity or disease etiology; <br />Charges for treatment or services for Temporomandibular Joint (TMJ) Syndrome, orofacial, or myofacial syndrome <br />whether medical or dental in scope; <br />Charges for reversal procedures in connection with previous male or female sterilization; <br />Charges for services related to educational or vocational testing or training; <br />Any charges for abortions which are not medically necessary; <br />Any charges for outpatient food, food supplements or vitamins; <br />Any charges for prescription drugs or durable medical equipment; <br />Surgery to correct vision problems which are not caused by sickness or injury; <br />Charges for treatment of male or female infertility; in vitro and in vivo fertilization of an ovum, or artificial <br />insemination including but not limited to: <br />a. Drugs and medicine; <br />b. Diagnostic and surgical procedures including but not limited to: <br />. Aspiration of ovarian cysts; <br />. Harvesting or obtaining eggs; <br />. Other surgical treatment of infertility; <br />. Diagnostic laboratory and pathology procedures; and <br />. Diagnostic radiology, nuclear medicine and ultra sound procedures; <br />Charges made by a surgeon, nurse, dentist or doctor who: <br />a. Normally lives with the covered person; <br />b. Is a member of the covered person's family; or <br />c. Is the covered person's employer or another employee of the employer; or <br />d. Is contracted for or by a union, employee benefit association, trustee or similar organization or the employee <br />of a clinic contracted for or by any such organization; <br />Charges for custodial care; <br />Charges for care, treatment, services, supplies or confinements primarily for the convenience of the covered person, his <br />doctor, his family or other providers; <br />Charges related to smoking cessation; <br />Treatment received outside of the United States except for emergency treatment while traveling; <br />The processing of nuclear fission or fusion, or the processing, use, handling or transporting of radioactive material, <br />including but not limited to nuclear reactors or any weapon of war or explosive device employing nuclear fission or <br />fusion. <br /> <br />IS. <br /> <br />16. <br />17. <br />18. <br />19. <br />20. <br />21. <br /> <br />22. <br />23. <br />24. <br />25. <br />26. <br />27. <br />28. <br /> <br />C:\Documcnts and Settings\pnderson\Loca1 Scttings\TCß1)Orary Internet Filcs\OLKS\EarlyReLdoc <br />