19. Contraceptive Products and Counseling, unless covered elsewhere in this SPD. 20. Cosmetic Treatment, Cosmetic Surgery, or any portion thereof, unless the procedure is otherwise listed as a covered benefit. 21. Court-Ordered: Any treatment or therapy that is court-ordered, or that is ordered as a condition of parole, probation, or custody or visitation evaluation, unless such treatment or therapy is normally covered by this Plan. This Plan does not cover the cost of classes ordered after a driving-while- intoxicated conviction or other classes ordered by the court. 22. Custodial Care as defined in the Glossary of Terms of this SPD. 23. Dental Services, unless covered elsewhere in this SPD. 24. Developmental Delays: Medical charges and occupational, physical, or speech therapy services related to Developmental Delays, intellectual disability, or behavioral therapy. 25. Duplicate Services and Charges or Inappropriate Billing, including the preparation of medical reports and itemized bills. 26. Education: Charges for education, special education, job training, music therapy, and recreational therapy, whether or not given in a facility providing medical or psychiatric care. This exclusion does not apply to self-management education programs for diabetics. 27. Environmental Devices: Environmental items such as, but not limited to, air conditioners, air purifiers, humidifiers, dehumidifiers, furnace filters, heaters, vaporizers, and vacuum devices. 28. Examinations: Examinations for employment, insurance, licensing, or litigation purposes. 29. Excess Charges: Charges or the portion thereof that are in excess of the Recognized Amount, the Usual and Customary charge, the Negotiated Rate, or the fee schedule. This exclusion does not apply to payments that may be required under the No Surprises Act. 30. Experimental, Investigational, or Unproven: Services, supplies, medicines, treatment, facilities, or equipment that the Plan determines are Experimental, Investigational, or Unproven, including administrative services associated with Experimental, Investigational, or Unproven treatment. This exclusion does not apply to Qualifying Clinical Trials as described in the Covered Medical Benefits section of this SPD. 31. Extended Care: Any Extended Care Facility Services that exceed the appropriate level of skill required for treatment as determined by the Plan. 32. Family Planning: Consultations for family planning. 33. Financial Counseling. 34. Fitness Programs: General fitness programs, exercise programs, exercise equipment, and health club memberships, or other utilization of services, supplies, equipment, or facilities in connection with weight control or bodybuilding. 35. Foot Care (Podiatry): Routine foot care. 36. Genetic Counseling, unless covered elsewhere in this SPD. 37. Genetic Testing, unless covered elsewhere in this SPD. 38. Growth Hormones. 39. Hearing Services: Purchase or fitting of hearing aids unless covered elsewhere in this SPD. -92- 7670-00-413597
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