2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 66
GENERAL EXCLUSIONS AND LIMITATIONS
No payment will be eligible under any portion of this Medical Plan for expenses Incurred by a Covered Person for
the expenses or circumstances listed below. If an expense is paid that is found to be excluded or limited as shown
below, the Medical Plan has the right to collect that amount from the payee, the Covered Person or from future
benefits and any such payment does not waive the written exclusions, limitations or other terms of the Medical Plan.
(1)
Abortions: Expenses related to abortions will not be considered eligible.
(2)
Acupuncture: Expenses for acupuncture will not be considered eligible.
(3)
Administrative Services: Expenses for claim forms, shipping and handling, and sales tax will not be
considered eligible.
(4)
After Termination Date: Expenses which are Incurred after the termination date of your coverage under the
Medical Plan will not be considered eligible.
(5)
Alcohol: Expenses Incurred for services, supplies, care or treatment of an Injury or Illness which occurred as
a result of that Covered Person’s illegal use of alcohol will not be considered eligible. The arresting officer’s
determination of inebriation will be sufficient for this exclusion. Expenses will be covered for injured Covered
Persons other than the person illegally using alcohol. Treatment as specified in the Medical Plan. This
exclusion does not apply if the Injury resulted from an act of domestic violence or a medical (including both
physical and mental health) condition.
(6)
Biofeedback: Expenses related to biofeedback will not be considered eligible.
(7)
Breast Surgery: Expenses for treatment of gynecomastia will not be considered eligible.
(8)
Cardiac Rehabilitation: Expenses in connection with Phase III cardiac rehabilitation, including, but not limited
to occupational therapy or work hardening programs will not be considered eligible. Phase III is defined as the
general maintenance level of treatment, with no further medical improvements being made and exercise
therapy that no longer requires the supervision of medical professionals.
(9)
Chelation Therapy: Expenses for chelation therapy will not be considered eligible, unless due to heavy metal
poisoning.
(10) Close Relative: Expenses for services, care or supplies provided by a person who normally resides in the
Covered Person’s home or by a Close Relative will not be considered eligible.
(11) Cognitive and Kinetic Therapy: Expenses for cognitive therapy and kinetic therapy will not be considered
eligible. Cognitive therapy is defined as therapy which embraces mental activities associated with thinking,
learning and memory. Kinetic therapy is defined as therapy related to motion or movement (e.g., the study of
motion, acceleration or rate of change). This exclusion will not apply to the diagnosis, testing and treatment
of ADD, ADHD or autism.
(12) Complications: Expenses for care, services or treatment required as a result of complications from a
treatment or procedure not covered under the Medical Plan will not be considered eligible.
(13) Contraceptives: Expenses for contraceptive procedures and devices, including but not limited to, oral
contraceptives, morning after pills, or patches (unless for purposes other than birth control and determined to
be Medically Necessary), and the placement or removal of a contraceptive device will not be considered
eligible.
(14) Controlled Substance: Expenses for services, supplies, care or treatment to a Covered Person for Injury or
Illness resulting from that Covered Person’s voluntary taking of or being under the influence of any controlled
substance, drug, hallucinogen or narcotic not administered on the advice of a Physician will not be considered
eligible. Expenses will be covered for injured Covered Persons other than the person using controlled
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