This is a delegate listing of major exclusions and limitations. A more detailed listing can also be found out easily in the Combined Evidence of Coverage and Disclosure Form/Certificate.

Exclusions and Limitations Common to All Medical Plans:

Any amounts in excess of the maximum amounts as stated in the Combined Evidence of Coverage and Disclosure Form/Certificate.

Any conditions for which benefits are recovered easily or can be recovered either by adjudication, settlement or otherwise, under any workers' reward, employer's liability law or occupational disease law, even if you do not declare them.

Hearing aids

Services that are being used for weight reduction or other treatments that are being used for obesity primarily occupy abundant weight reduction as the major method of treatment, except medically treatment of morbid obesity with Blue Cross former authorization.Sterilization reversal and other services for infertility except as specifically stated in the Combined Evidence of Coverage and Disclosure Form/Certificate. Any amounts in excess of the lifetime maximum for infertility services.Procedures for amending each and every characteristics of the body to those of the opposite sex. This may even include any medical, surgical or psychiatric treatment or studies related to sex changes.

Every dental services, together with diagnostic, preventative, x-rays, dentures, bridges, crowns, caps, orthodontic services, braces and other orthodontic appliances and supplies, dental implants and related procedures, except as specifically stated in the Combined Evidence of Coverage and Disclosure Form/Certificate.Cosmetic surgery or some other services are performed for varying normal structures of the body for the sake of perking up appearance.

Custom physical examinations for insurance, employment license or school.

Treatment of mental or nervous disorders or psychological testing except as specifically stated under the benefits section of the Combined Evidence of Coverage and Disclosure Form/Certificate.

Custodial care.

Services which are tentative in nature.

Educational services, except as specifically provided or set by Blue Cross. Nutritional counseling as specifically provided or arranged by Blue Cross exceptionally.

Services offered by a local, state or federal government agency, except when payment is expressly required by federal or state law.Conditions caused by an act of war or the unintended release of nuclear energy when government funds are accessible for treatment of illness or injury take place from such release of nuclear energy.Inpatient room along with board charges in connection with a hospital stay principally for diagnostic tests on an outpatient basis which could have been achieved safely.If not your physician determines that oral contraceptive drugs contraceptive devices are not medically apt.Consultations are provided by telephone or facsimile machines.

Health club memberships.

Services for which you are entitled to receive Medicare benefits, whether or not they are actually paid.

Charges in excess of the limited fee schedule and reasonable and customary amounts determined by Blue Cross.

Suppose the plan is deemed medically necessary to prevent complications of phenylketonuria (PKU) food supplements for formulas and special food products that are prescribed by a physician in consultation with a metabolic disease specialist.