2026 CODAC Benefit Summaries and Carrier Flyers

18. Court-Ordered: Any treatment or therapy that is court-ordered, or that is ordered as a condition of parole, probation, or custody or visitation evaluation, unless such treatment or therapy is normally covered by this Plan.

19. Custodial Care as defined in the Glossary of Terms section of this SPD.

20.

Dental Services, unless covered elsewhere in this SPD .

21. Duplicate Services and Charges or Inappropriate Billing, including the preparation of medical reports and itemized bills.

22. Education: Services that are solely educational in nature or otherwise paid under state or federal law for purely educational purposes. This exclusion does not apply to the educational component of a clinical treatment plan that requires clinical educational services provided by a licensed or registered health care professional when there is a lack of knowledge on self-management of the disease.

23. Environmental Devices: Environmental items such as, but not limited to, air conditioners, air purifiers, humidifiers, dehumidifiers, furnace filters, heaters, vaporizers, and vacuum devices.

24. Examinations: Examinations for employment, insurance, licensing, or litigation purposes.

25. Excess Charges: Charges or the portion thereof that are in excess of the Recognized Amount, the Usual and Customary charge, or the Negotiated Rate. This exclusion does not apply to payments that may be required under the No Surprises Act. 26. Experimental, Investigational, or Unproven: Services, supplies, medicines, treatment, facilities, or equipment that the Plan determines are Experimental, Investigational, or Unproven, including administrative services associated with Experimental, Investigational, or Unproven treatment. This exclusion does not apply to Qualifying Clinical Trials as described in the Covered Medical Benefits section of this SPD.

27. Extended Care: Any Extended Care Facility Services that exceed the appropriate level of skill required for treatment as determined by the Plan.

28.

Family Planning: Consultations for family planning.

29.

Financial Counseling .

30. Fitness Programs: General fitness programs, exercise programs, exercise equipment, and health club memberships, or other utilization of services, supplies, equipment, or facilities in connection with weight control or bodybuilding.

31.

Foot Care (Podiatry): Routine foot care.

32. Foreign Coverage for Medical Care Expenses, Including Preventive Care or Elective Treatment, except for services that are Incurred in the event of an Emergency.

33. Genetic Testing or Genetic Counseling, unless covered elsewhere in this SPD.

34. Growth Hormones, unless covered elsewhere in this SPD.

35.

Home Births and associated costs.

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