68 Excluded treatment includes but is not limited to preventive care and fluoride treatments; dental X - rays, supplies, appliances and all associated costs; and diagnosis and treatment for the teeth, jaw or gums such as: • Removing, restoring , or replacing teeth; • Medical care or surgery for dental problems (unless listed as a Covered Service in this Booklet); • Services to help dental clinical outcomes. Dental treatment for injuries that are a result of biting or chewing is also excluded. This Exclusion does not apply to services that the Plan must cover by law. 24) Drugs Contrary to Approved Medical and Professional Standards Drugs given to you or prescribed in a way that is against approved medical and professional standards of practice. 25) Drugs Over Quantity or Age Limits Drugs which are over any quantity or age limits set by the Plan or us. 26) Drugs Over the Quantity Prescribed or Refills After One Year Drugs in amounts over the quantity prescribed, or for any refill given more than one year after the date of the original Prescription Order. 27) Drugs That Do Not Need a Prescription Drugs that do not need a prescription by federal law (including Drugs that need a prescription by state law, but not by federal law), except for injectable insulin or other Drugs provided in the Preventive Care paragraph of the "What’s Covered" section . 28) Drugs Prescribed by Providers Lacking Qualifications/Certifications Prescription Drugs prescribed by a Provider that does not have the necessary qualifications and including certifications as determined by the Plan. 29) Educational Services Services, supplies or room and board for teaching, vocational, or self - training purposes. This includes, but is not limited to, boarding schools and/or the room and board and educational components of a residential program where the primary focus of the p rogram is educational in nature rather than treatment based. 30) Experimental or Investigational Services Services or supplies that are found to be Experimental / Investigational. This also applies to services related to Experimental / Investigational services, whether you get them before, during, or after you get the Experimental / Investigational service or supply. The fact that a service or supply is the only available treatment will not make it Covered Service if we conclude it is Experimental / Investigational. Details on the criteria we use to determine if a Service is Experimental or Investigational is outlined below. 31) Eyeglasses and Contact Lenses Eyeglasses and contact lenses to correct your eyesight unless listed as covered in this Booklet. This Exclusion does not apply to lenses needed after a covered eye surgery. 32) Eye Exercises Orthoptics and vision therapy. 33) Eye Surgery Eye surgery to fix errors of refraction, such as near - sightedness. This includes, but is not limited to, LASIK, radial keratotomy or keratomileusis, and excimer laser refractive keratectomy. 34) 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. 35) 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.
2026 Anthem Certificate Plan A Page 68 Page 70