Noblesville Schools Medical Plan 61 Section 2: Exclusions and Limitations Personal Care, Comfort or Convenience 1. Television. 2. Telephone. 3. Beauty/barber service. 4. Guest service. 5. Supplies, equipment and similar incidental services and supplies for personal comfort. Examples include: ▪ Air conditioners, air purifiers and filters and dehumidifiers. ▪ Batteries and battery chargers. ▪ Breast pumps. This exclusion does not apply to breast pumps for which Benefits are provided under the Health Resources and Services Administration (HRSA) requirement. ▪ Car seats. ▪ Chairs, bath chairs, feeding chairs, toddler chairs, chair lifts and recliners. ▪ Exercise equipment. ▪ Home modifications such as elevators, handrails and ramps. ▪ Hot and cold compresses. ▪ Hot tubs. ▪ Humidifiers. ▪ Jacuzzis. ▪ Mattresses. ▪ Medical alert systems. ▪ Motorized beds. ▪ Music devices. ▪ Personal computers. ▪ Pillows. ▪ Power-operated vehicles. ▪ Radios. ▪ Safety equipment. ▪ Saunas. ▪ Stair lifts and stair glides. ▪ Strollers. ▪ Treadmills. ▪ Vehicle modifications such as van lifts. ▪ Video players. ▪ Whirlpools.
[UHC] HDHP Basic - Medical Plan Summary Page 67 Page 69