65 36. Family Members Services prescribed, ordered, referred by or given by a member of your immediate family, including your spouse, child, brother, sister, parent, in-law, or self. 37. Foot Care Routine foot care unless Medically Necessary. This Exclusion applies to cutting or removing corns and calluses; trimming nails; cleaning and preventive foot care, including but not limited to: a) Cleaning and soaking the feet. b) Applying skin creams to care for skin tone. c) Other services that are given when there is not an illness, injury or symptom involving the foot. 38. Foot Orthotics Foot orthotics, orthopedic shoes or footwear or support items unless used for a systemic illness affecting the lower limbs, such as severe diabetes, or as required by law. 39. Foot Surgery Surgical treatment of flat feet; subluxation of the foot; weak, strained, unstable feet; tarsalgia; metatarsalgia; hyperkeratosis. 40. Fraud, Waste, Abuse, and Other Inappropriate Billing Services from a Non-Participating Provider that are determined to be not payable as a result of fraud, waste, abuse or inappropriate billing activities. This includes a Non-Participating Provider's failure to submit medical records required to determine the appropriateness of a claim. 41. Free Care Services you would not have to pay for if you didn’t have this Plan. This includes, but is not limited to government programs, services during a jail or prison sentence, services you get from Workers’ Compensation, and services from free clinics. If your Employer is not required to have Workers’ Compensation coverage, this Exclusion does not apply. This Exclusion will apply if you get the benefits in whole or in part. This Exclusion also applies whether or not you claim the benefits or compensation, and whether or not you get payments from any third party. 42. Growth Hormone Treatment Any treatment, device, drug, service or supply (including surgical procedures, devices to stimulate growth and growth hormones), solely to increase or decrease height or alter the rate of growth. 43. Health Club Memberships and Fitness Services Health club memberships, workout equipment, charges from a physical fitness or personal trainer, or any other charges for activities, equipment, or facilities used for physical fitness, even if ordered by a Doctor. This Exclusion also applies to health spas. 44. Hearing Aids Hearing aids , including bone-anchored hearing aids, or exams to prescribe or fit hearing aids and over-the-counter hearing aids, unless listed as covered in this Booklet. This Exclusion does not apply to cochlear implants. 45. Home Health Care a) Services given by registered nurses and other health workers who are not employees of or working under an approved arrangement with a Home Health Care Provider. b) Private duty nursing. c) Food, housing, homemaker services and home delivered meals. 46. Hospital Services Billed Separately Services rendered by Hospital resident Doctors or interns that are billed separately. This includes separately billed charges for services rendered by employees of Hospitals, labs or other institutions, and charges included in other duplicate billings. 47. Hyperhidrosis Treatment Medical and surgical treatment of excessive sweating (hyperhidrosis). 48. Infertility Treatment Testing or treatment related to infertility.
2025 Retiree Indemnity Plan Booklet Page 65 Page 67