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What is Not Eligible for Sharing

Medical bills related to the following conditions are not eligible for sharing:

  • 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;
  • Drug/alcohol treatment or rehabilitation that is residential (inpatient) or outpatient;
  • Procedure or surgery that is not medically necessary;
  • Prophylactic (treatment intended to prevent disease) and preventive surgery without a personal history of diagnosis and a doctor’s recommendation;
  • Voluntary procedures/treatment, including cosmetic surgery or gender-affirming (transgender-related) surgery.
  • 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 the “Preventative Screening” or “Wellness” sections 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;
  • Transportation to appointments;
  • Cosmetic, Transgender, or voluntary treatment or surgery;
  • Psychotropic medication;
  • Birth control;
  • Vaccinations and / or immunizations;
  • Treatment for members aged 65 or older that is not Medicare-eligible;
  • Treatments, procedures, and medications that are not FDA and CMS approved;
  • Complications related to ineligible procedures, conditions, and diagnoses. This includes any future-related needs.