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Child Health Plus

Benefit Package Exclusions

Article The following services will NOT be covered:

• Experimental medical or surgical procedures. • Experimental drugs. • Drugs which can be bought without prescription, except as defined. • Prescription drugs used for purposes of treating erectile dysfunction. • Prescription drugs and biologicals and the administration of these drugs and biologicals that are furnished for the purpose of causing or assisting in causing the death, suicide, euthanasia or mercy killing of a person. • Private duty nursing. • Home health care, except as defined. • Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column. • Services in a skilled nursing facility. • Cosmetic, plastic, or reconstructive surgery, except as defined. • In vitro fertilization, artificial insemination or other means of conception and infertility services. • Services covered by another payment source. • Durable Medical Equipment and Medical Supplies, except as defined. • Transportation, except as defined. • Personal or comfort items. • Orthodontia Services. • Services which are not medically necessary.