Excluded Services
Your Plan generally does not cover the following services. For more details and a comprehensive list, please check your policy or Plan Document.
Acupuncture
Cosmetic surgery (except after mastectomy or due to defects from injury or disease)
Dental care (Adult)
Dental care (Children)
Hearing aids
Infertility treatment
Routine eye care (Adult)
Routine eye care (Children)
Routine foot care
Weight loss programs (except as required by ACA)
Other Covered Services
The Plan also covers the following services, but limitations may apply. This list is not complete. Refer to your Plan Document for full details.
Bariatric surgery (prior approval required)
Chiropractic services (up to 30 visits per individual per year)
Non-emergency care when traveling outside the U.S.
Private-duty nursing (prior approval required)