Fertility / Infertility treatment is ineligible for sharing.
Other treatments ineligible for sharing according to the guidelines:
• Treatment that is in violation of the Statement of Beliefs and Ethics including illness or injury arising from grossly negligent acts, use of illegal drugs, abuse of alcohol or any illegal activity, whether or not an arrest is made, charges are filed, or a conviction results.
• Treatment related to current use of illegal drugs
• Residential drug/alcohol treatment
• Procedures or surgery that is not medically
necessary
• Prophylactic (treatment intended to prevent
disease) and preventive surgery without
personal history of diagnosis and a doctor’s
recommendation
• Inpatient rehab
• Inpatient and Outpatient drug/alcohol
rehabilitation
• Inpatient mental health services
• Nutrition services
• Alternative or naturopathic treatment
• Experimental treatment
• Genetic testing not required for treatment of
an existing condition
• Hearing aids
• Non-prescription (over-the-counter) drugs and
medical supplies/equipment.
• Fertility/infertility treatment
• Direct Primary Care costs
• Medical marijuana
• Routine or preventive care not listed in Section
D. above
• Sleep studies not related to a specific disease or
disorder
• Treatment related to genetic defects, hereditary
diseases, or congenital conditions present
before membership
• Weight management treatment or procedures
• Dental or Vision services not related to a
medical injury or illness.
• Orthotics are not eligible for sharing.
• Transportation to appointments
• Cosmetic, Transgender, or voluntary treatment
or surgery
• Psychotropic medication
• Birth control
• Vaccinations and / or immunizations
• Treatment for members age 65 or older that is
not Medicare-eligible
- Pre-Existing Medical Conditions are
conditions in which known signs, symptoms,
testing, diagnosis, treatment, or use of
medication occurred within 36 months prior
to membership (based on medical records). - High blood pressure or high cholesterol that
is controlled through medication will not be
considered a Pre-Existing Medical Condition
for purposes of determining eligibility for
future vascular or cardiac events. - The Pre-Existing Medical Condition limitations
do not apply to members 65 years old and older.