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* For more information about limitations and exceptions, see the plan or policy document at www.HorizonBlue.com/members. 5 of 8Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) Acupuncture Bariatric surgery Cosmetic Surgery Dental care (Adult) Long Term Care Routine foot care Weight Loss Programs Other Covered Services (Limitations may apply to these services. T plan document.) Chiropractic careHearing Aids (Only covered for Members age 15 or younger) Infertility treatment Most coverage provided outside the United States. See www.HorizonBlue.com Non-emergency care when traveling outside the U.S. See www.HorizonBlue.com Private-duty nursingRoutine eye care (Adult) 22