HomeMy WebLinkAboutRESPONSE - RFP - P682 BENEFITS (14)23. Charges for support garments; disposable medical supplies used at home: devices used at home to perform tests on
body substances. Except that insurance is provided for test strips and glucometers used by diabetics and subject to
Deductible and benefit percentage shown in the Schedule of Benefits.
24. Charges for the purchase or repair of hearing aids, if Hearing Aid Benefits are not included in this policy.
25. Charges for the treatment of refractive errors, including but not limited to, eye exams and radial keratotomy
procedures.
26. Charges for treatment by a doctor which is not within the scope of his or her license.
27. Charges for vision therapy by any name called.
28. Charges for vocational rehabilitation, by any name called.
29. Charges for which benefits are not provided in this policy.
30. Charges incurred for the reversal of sterilization.
31. Charges incurred or disability claimed while an Insured Individual is not under the direct care of a doctor.
32. Charges related to changing the sex of an individual.
33. Charges which are in excess of the reasonable and customary charges for services and materials.
34. Charges which are not medically necessary to the care or treatment of an illness or injury except as described
elsewhere in this Policy.
35. Charges which the Insured Individual is not legally obliged to pay.
36. Charges which would not have been made if no insurance existed.
37. Contraceptive devices and implants. This includes oral contraceptives unless listed as a Covered Charge under the
Prescription Drug Benefit.
38. Losses which are due to war or any act of war, whether declared or undeclared.
39. Surgery for morbid obesity, unless medically necessary and appropriate treatment measures have failed for reasons
other than compliance of the Insured Individual.
40. The rental or purchase of aids, including but not limited to, ramps, elevators, stair lifts, swimming pools, air filtering
systems, environmental control equipment, spas, hot tubs, or automobile hand controls, or any modification made to
dwellings, property or motor vehicles.
41. To the extent that a natural disaster, war, riot, civil insurrection, epidemic, labor dispute not involving the Policy, or that
other similar circumstances not within the control of the Policy results in the facilities, personnel or financial resources
of the Policy being unavailable to arrange for the provisions of benefits under the Policy, the Policy's obligation to
provide such services or benefits will be limited to the requirement that TakeCare make a good faith effort to provide or
arrange for the provision of such services or benefits within the resulting limitations on the availability of its facilities,
personnel or resources, and the Policy will have no liability or obligation as a result of any delay or failure to provide
services or benefits under the Policy.
02/98