40. Home Births and associated costs. 41. Home Modifications: Modifications to Your home or property, such as, but not limited to, escalators, elevators, saunas, steam baths, pools, hot tubs, whirlpools, tanning equipment, wheelchair lifts, stair lifts, or ramps. 42. Infant Formula not administered through a tube as the sole source of nutrition for the Covered Person. 43. Infertility Treatment: • Fertility tests. • Surgical reversal of a sterilized state that was a result of a previous surgery. • Direct attempts to cause pregnancy by any means, including, but not limited to, hormone therapy or drugs. • Artificial insemination; in vitro fertilization; gamete intrafallopian transfer (GIFT), or zygote intrafallopian transfer (ZIFT). • Embryo transfer. • Freezing or storage of embryo, eggs, or semen. • Genetic testing. This exclusion does not apply to services required to treat or correct underlying causes of infertility where such services cure the condition of, slow the harm to, alleviate the symptoms of, or maintain the current health status of the Covered Person. 44. Intraocular Lenses Other Than Conventional Intraocular Cataract Lenses. 45. Lamaze Classes or other childbirth classes. 46. Learning Disability: Non-medical treatment, including, but not limited to, special education, remedial reading, school system testing, and other rehabilitation treatment for a Learning Disability. If another medical condition is identified through the course of diagnostic testing, any coverage of that condition will be subject to Plan provisions. 47. Liposuction, unless covered elsewhere in this SPD. 48. Maintenance Therapy if, based on medical evidence, treatment or continued treatment could not be expected to resolve or improve a condition, or if clinical evidence indicates that a plateau has been reached in terms of improvement from such services. 49. Mammoplasty or Breast Augmentation, unless covered elsewhere in this SPD. 50. Marriage Counseling. 51. Massage Therapy. 52. Maximum Benefit. Charges in excess of the Maximum Benefit allowed by the Plan. 53. Military: A military-related Illness of or Injury to a Covered Person on active military duty, unless payment is legally required. 54. Nocturnal Enuresis Alarm. 55. Non-Custom-Molded Shoe Inserts. 56. Non-Professional Care: Medical or surgical care that is not performed according to generally accepted professional standards, or that is provided by a provider acting outside the scope of his or her license. -93- 7670-00-413597