Page 49 - Benefits Summary 2018-2019 b_Neat
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Excluded 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 Habilitation services Private-duty nursing
Bariatric surgery Hearing aids Routine eye care (Adult)
Cosmetic surgery Infertility treatment Routine eye care (Children)
Dental care (Adult) Long-term care Routine foot care
Dental care (Children) Non-emergency care when traveling outside of the U.S. Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
Chiropractic care (20 visits)
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