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Cleanings covered 2 times per 12
No charge Not covered months. Additional limitations may
check-up
apply.
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.)
Cosmetic surgery Long-term care Routine foot care
Dental care (Adult) Non-emergency care when traveling outside the U.S. Weight loss programs
Infertility treatment Private-duty nursing
Other Covered Services (Limitations may apply to t our plan document.)
Acupuncture Chiropractic care Routine eye care (Adult)
Bariatric surgery Hearing aids
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