Services or supplies that are not listed in the coverage certificate, that are not ordered by your Primary Care Physician, Woman’s Principal Health Care Provider, or that you are entitled to under workers’ compensation or other laws.

Treatment that is not pre-certified, when required, as explained in your certificate of coverage (terms of coverage).

Services or supplies that were received before the date your coverage began or after the date your coverage ended.

Services or supplies furnished by or available from the local, state or federal government.

Services for which benefits are duplicated because the spouse, parent and/or child are employees of the University and each is covered separately by the plan.

Services or supplies provided as the result of an injury caused by another person to the extent that you have collected damages for such injury and that the plan has provided benefits for the services or supplies in connection with such injury.

Services or supplies that do not meet accepted standards of medical or dental practice including, but not limited to, services which are investigational or experimental in nature.

Custodial care services.

Services or supplies to treat behavioral, social maladjustment, lack of discipline or other antisocial actions that are not specifically the result of a mental illness.

Special educational therapy such as music or recreational therapy.

Cosmetic surgery and related services and supplies, except correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors or diseases.

Charges for failure to keep a scheduled visit or for completion of a claim form.

Services or supplies received from a dental or medical department or clinic maintained by an employer, labor union or other similar person or group.

Services or supplies for which you are not required to make payment or would have no legal obligation to pay if you did not have this or similar coverage.

Personal hygiene, comfort or convenience items such as air conditioners, humidifiers, physical fitness equipment, televisions and telephones, commonly used for purposes other than medical reasons.

Special braces, splints, specialized equipment, appliances, ambulatory apparatus or battery or atomically controlled implants, except as specifically stated in the HMO’s certificate.

Prosthetic devices, special appliances or surgical implants which are for cosmetic purposes, the comfort or convenience of the patient or unrelated to the treatment of a disease or injury.

Nutritional items such as infant formula, weight-loss supplements and over-the-counter food substitutes.

Blood derivatives that are not classified as drugs in the official formularies.

Marriage counseling.

Hypnotism.

Outpatient private duty nursing.

Routine podiatric care such as corn callus removal.

Services or supplies that are rendered for the care, treatment, filling, removal, replacement or artificial restoration of the teeth or structures directly supporting the teeth except as specifically stated in this Certificate.

Treatment of temporomandibular joint syndrome with intraoral prosthetic devices or any other method which alters vertical dimension or treatment of temporomandibular joint dysfunction not caused by documented organic joint disease or physical trauma.

Services or supplies rendered for human organ tissue transplants except as specifically provided for in this Certificate.

For any illness or injury occurring on or after your coverage date as a result of war or an act of war.