57. Not Medically Necessary: Services, supplies, treatment, facilities, or equipment that the Plan determines are not Medically Necessary. Furthermore, this Plan excludes services, supplies, treatment, facilities, or equipment that reliable scientific evidence has shown does not cure the condition, slow the degeneration/deterioration or harm attributable to the condition, alleviate the symptoms of the condition, or maintain the current health status of the Covered Person. See also Maintenance Therapy above. 58. Nursery and Newborn Expenses for a grandchild of a covered Employee or spouse. 59. Nutrition Counseling, unless covered elsewhere in this SPD. 60. Nutritional Supplements, Enteral Feedings, Vitamins, and Electrolytes unless covered elsewhere in this SPD. 61. Over-the-Counter Medication, Products, Supplies, or Devices, unless covered elsewhere in this SPD. 62. Palliative Foot Care. 63. Panniculectomy unless determined by the Plan to be Medically Necessary. 64. Personal Comfort: Services or supplies for personal comfort or convenience, such as, but not limited to, private rooms, televisions, telephones and guest trays. 65. Pharmacy Consultations. Charges for or related to consultative information provided by a pharmacist regarding a Prescription order, including, but not limited to, information related to dosage instruction, drug interactions, side effects, and the like. 66. Preventive / Routine Care Services, unless covered elsewhere in this SPD. 67. Reconstructive Surgery when performed only to achieve a normal or nearly normal appearance, and not to correct an underlying medical condition or impairment, as determined by the Plan, unless covered elsewhere in this SPD. 68. Return to Work / School: Telephone or Internet consultations, or the completion of claim forms or forms necessary for a return to work or school. 69. Reversal of Sterilization: Procedures or treatments to reverse prior voluntary sterilization, unless covered by the Plan in connection with Infertility Treatment. 70. Room and Board Fees when surgery is performed other than at a Hospital or Surgical Center. 71. Self-Administered Services or procedures, including self-administered or self-infused medications, that can be performed by the Covered Person without the presence of medical supervision. This exclusion does not apply to medications that, due to their characteristics (as determined by the claims administrator), must typically be administered or directly supervised by a qualified provider or licensed/certified health professional in an Outpatient setting. This exclusion does not apply to hemophilia treatment centers contracted to dispense hemophilia factor medications directly to members for self-infusion. 72. Services at No Charge or Cost: Services for which the Covered Person would not be obligated to pay in the absence of this Plan or that are available to the Covered Person at no cost, or for which the Plan has no legal obligation to pay, except for care provided in a facility of the uniformed services as per Title 32 of the National Defense Code, or as required by law. 73. Services Provided By a Close Relative. See the Glossary of Terms section of this SPD for a definition of Close Relative. 74. Services Provided By a School. -94- 7670-00-413597