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Routine physical examinations – first 12 months
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Maternity and newborns – first 12 months
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Mental and nervous – first 12 months
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Dental treatment unless accident related
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Organized amateur or professional sports
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Treatment not ordered or received by a physician
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Treatment or supplies not medically necessary
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Investigational, experimental or research procedures
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Custodial care
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Weight modification
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Elective cosmetic or plastic surgery
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Treatment of impotency
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Contraceptive medication or treatment
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Drug and alcohol abuse treatment
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Organ transplants not specifically listed
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Devices to correct sight or hearing
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Routine foot care
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Treatment by a relative or family member
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Treatment as a result of war or riot
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Treatment resulting from illegal activities
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Speech therapy
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Persons HIV+ at effective date
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Services and treatment eligible for payment by any government or other
insurance