Noblesville Schools Medical Plan 60 Section 2: Exclusions and Limitations ▪ Hair removal, except as part of a genital reconstruction procedure by a physician for the treatment of Gender Dysphoria. ▪ Hair transplantation. ▪ Lip augmentation. ▪ Lip reduction. ▪ Liposuction. ▪ Mastopexy. ▪ Pectoral implants for chest masculinization. ▪ Rhinoplasty. ▪ Skin resurfacing. Medical Supplies and Equipment 1. Prescribed or non-prescribed medical supplies and certain disposable supplies. This exclusion does not apply to: ▪ Disposable supplies necessary for the effective use of DME or prosthetic devices for which Benefits are provided as described under Durable Medical Equipment (DME), Orthotics and Supplies and Prosthetic Devices in Section 1: Covered Health Care Services. This exception does not apply to supplies for the administration of medical food products. ▪ Diabetic supplies for which Benefits are provided as described under Diabetes Services in Section 1: Covered Health Care Services. ▪ Ostomy supplies for which Benefits are provided as described under Ostomy Supplies in Section 1: Covered Health Care Services. ▪ Urinary catheters and related urologic supplies for which Benefits are provided as described under Urinary Catheters in Section 1: Covered Health Care Services. 2. Tubings and masks except when used with DME as described under Durable Medical Equipment (DME), Orthotics and Supplies in Section 1: Covered Health Care Services. 3. Prescribed or non-prescribed publicly available devices, software applications and/or monitors that can be used for non-medical purposes. 4. Repair or replacement of DME or orthotics due to misuse, malicious damage or gross neglect or to replace lost or stolen items. Nutrition 1. Non-preventive nutritional counseling that is non-disease specific nutritional education such as general good eating habits. This exclusion does not apply to preventive care for which Benefits are provided under the United States Preventive Services Task Force or to Benefits provided under Non-Preventive Nutritional Counseling as described in Section 1: Covered Health Care Services. 2. Food of any kind, infant formula, standard milk-based formula, and donor breast milk. This exclusion does not apply to specialized enteral formula for which Benefits are provided as described under Enteral Nutrition in Section 1: Covered Health Care Services. 3. Nutritional or cosmetic therapy using high dose or mega quantities of vitamins, minerals or elements and other nutrition-based therapy. Examples include supplements and electrolytes.