Noblesville Schools Medical Plan 66 Section 2: Exclusions and Limitations All Other Exclusions 1. Health care services and supplies that do not meet the definition of a Covered Health Care Service. Covered Health Care Services are those health services, including services, supplies, or Pharmaceutical Products, which the Claims Administrator determines to be all of the following: ▪ Provided for the purpose of preventing, evaluating, diagnosing or treating a Sickness, Injury, Mental Illness, substance-related and addictive disorders, condition, disease or its symptoms. ▪ Medically Necessary. ▪ Described as a Covered Health Care Service in this SPD under Section 1: Covered Health Care Services and in the Schedule of Benefits. ▪ Not otherwise excluded in this SPD under Section 2: Exclusions and Limitations. 2. Physical, psychiatric or psychological exams, testing, all forms of vaccinations and immunizations or treatments that are otherwise covered under the Plan when: ▪ Required only for school, sports or camp, travel, career or employment, insurance, marriage or adoption. ▪ Related to judicial or administrative proceedings or orders unless Medically Necessary. ▪ Conducted for purposes of medical research. This exclusion does not apply to Covered Health Care Services provided during a clinical trial for which Benefits are provided as described under Clinical Trials in Section 1: Covered Health Care Services. ▪ Required to get or maintain a license of any type. 3. Health care services received as a result of war or any act of war, whether declared or undeclared or caused during service in the armed forces of any country. This exclusion does not apply if you are a civilian injured or otherwise affected by war, any act of war, or terrorism in non-war zones. 4. Health care services received after the date your coverage under the Plan ends. This applies to all health care services, even if the health care service is required to treat a medical condition that started before the date your coverage under the Plan ended. 5. Health care services when you have no legal responsibility to pay, or when a charge would not ordinarily be made in the absence of coverage under the Plan. 6. Health care services when the Copayments, Coinsurance and/or deductible are waived, not pursued, or not collected by an out-of-Network provider. 7. Charges in excess of the Allowed Amount, when applicable, or in excess of any specified limitation. 8. Long term (more than 30 days) storage. Examples include cryopreservation of tissue, blood and blood products. 9. Autopsy. 10. Foreign language and sign language interpretation services offered by or required to be provided by a Network or out-of-Network provider. 11. Health care services related to a non-Covered Health Care Service: When a service is not a Covered Health Care Service, all services related to that non-Covered Health Care Service are also excluded. This exclusion does not apply to services the Claims Administrator would otherwise determine to be Covered Health Care Services if the service treats complications that arise from the non-Covered Health Care Service. For the purpose of this exclusion, a "complication" is an unexpected or unanticipated condition that is superimposed on an existing disease and that affects or modifies the prognosis of the original