66 49. Lost or Stolen Drugs Refills of lost or stolen Drugs. 50. Maintenance Therapy Rehabilitative treatment given when no further gains are clear or likely to occur. Maintenance therapy includes care that helps you keep your current level of function and prevents loss of that function, but does not result in any change for the better. This Exclusion does not apply to “Habilitative Services” as described in the “What’s Covered” section. 51. Medical Equipment, Devices and Supplies a) Replacement or repair of purchased or rental equipment because of misuse, abuse, or loss/theft. b) Surgical supports, corsets, or articles of clothing unless needed to recover from surgery or injury. c) Non-Medically Necessary enhancements to standard equipment and devices. d) Supplies, equipment and appliances, including wigs, that include comfort, luxury, or convenience items or features that exceed what is Medically Necessary in your situation. Reimbursement will be based on the Maximum Allowed Amount for a standard item that is a Covered Service, serves the same purpose, and is Medically Necessary. Any expense, including items you purchase with features that exceed what is Medically Necessary, will be limited to the Maximum Allowed Amount for the standard item, and the additional costs will be your responsibility. e) Disposable supplies for use in the home such as bandages, gauze, tape, antiseptics, dressings, ace-type bandages, and any other supplies, dressings, appliances or devices that are not specifically listed as covered in the “What's Covered” section. f) Continuous glucose monitoring systems. These are covered under the Prescription Drug Benefit at a Retail or Home Delivery (Mail Order) Pharmacy. 52. Medicare For which benefits are payable under Medicare Parts A, B, and/or D, or would have been payable if you had applied for Parts A and/or B, except as listed in this Booklet or as required by federal law, as described in the section titled "Medicare" in General Provisions. You should sign up for Medicare Part B as soon as possible to avoid large Out-of-Pocket costs. If you do not enroll in Medicare Part B when you are eligible, you may have large out-of-pocket costs. Please refer to Medicare.gov for more details on when you should enroll and when you are allowed to delay enrollment without penalties. 53. Missed or Cancelled Appointments Charges for missed or cancelled appointments. 54. Non-approved Drugs Drugs not approved by the FDA. 55. Non-Approved Facility Services from a Provider that does not meet the definition of Facility. 56. Non-Medically Necessary Services Services the Plan concludes are not Medically Necessary. This includes services that do not meet the Plan’s medical policy, clinical coverage, or benefit policy guidelines. 57. Nutritional or Dietary Supplements Nutritional and/or dietary supplements, except as described in this Booklet or that must be covered by law. This Exclusion includes, but is not limited to, nutritional formulas and dietary supplements that you can buy over-the-counter and those you can get without a written Prescription or from a licensed pharmacist. 58. Off label use Off label use, unless the Plan approves it, or when: (1) The Drug is recognized for treatment of the indication in at least one (1) standard reference compendium; (2) The Drug is recommended for that particular type of cancer and found to be safe and effective in formal clinical studies, the results of which have been published in a peer reviewed professional medical journal published in the United States or Great Britain. 59. Oral Surgery Extraction of teeth, surgery for impacted teeth and other oral surgeries for to treat the teeth or bones and gums directly supporting the teeth, except as listed in this Booklet. 60. Personal Care, Convenience and Mobile/Wearable Devices