2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 67
substances. 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.
(15) Convenience Items: Expenses for personal hygiene and convenience items will not be considered eligible.
(16) Cosmetic Procedures: Expenses for Cosmetic and reconstructive procedures will not be considered eligible,
except as specified under Eligible Medical Expenses.
(17) Counseling: Expenses for religious, marital, family, or relationship counseling will not be considered eligible,
except as specified under Hospice Care.
(18) Custodial Care: Expenses for Custodial Care will not be considered eligible, except as specified under the
Home Health Care and Hospice Care benefits.
(19) Dental Care: Expenses Incurred in connection with dental care, treatment, x-rays, general anesthesia or
Hospital expenses will not be considered eligible, except as specified under Eligible Medical Expenses.
(20) Developmental Delays: Expenses in connection with the treatment of developmental delays, including, but
not limited to speech therapy, occupational therapy, physical therapy and any related diagnostic testing will
not be considered eligible. This exclusion will not apply to expenses related to the diagnosis, testing and
treatment of ADD, ADHD or autism.
(21) Elastic Bandages: Expenses for elastic bandages will not be considered eligible, except for Medically
Necessary compression items.
(22) Exercise Programs: Expenses for exercise programs for treatment of any condition will not be considered
eligible, except for Physician-supervised cardiac rehabilitation and occupational or physical therapy covered
by the Medical Plan.
(23) Experimental and/or Investigational: Expenses for treatment, procedures, devices, services, supplies,
drugs or medicines which are determined to be Experimental and/or Investigational will not be considered
eligible. This exclusion will not apply to clinical trial programs covered under Eligible Medical Expenses
section of the Medical Plan.
This exclusion will also not apply if the treatment the Covered Person is receiving is the only treatment
available and/or is considered standard of care and does not violate church doctrine.
(24) Felony / Illegal Occupation: Expenses caused or contributed by a Covered Person committing or attempting
an assault, felony or criminal act, participating in an illegal occupation, or actively participating in a violent
disorder or riot will not be considered eligible. Actively participating does not include being at the scene of a
violent disorder or riot while performing their official duties. This exclusion will not apply to Injuries and/or
Illnesses sustained due to a medical condition (physical or mental) or domestic violence.
(25) Foot Care: Expenses for routine foot care, treatment of weak, unstable or flat feet will not be considered
eligible, unless due to a diabetic condition.
(26) Foot Orthotics: Expenses for foot orthotics, orthopedic shoes, arch supports or for the exam, prescription or
fitting thereof will not be considered eligible. This exclusion does not apply to therapeutic shoes due to a
diabetic condition. See coverage under Eligible Medical Expenses section of the Medical Plan.
(27) Governmental Agency: Expenses for services and supplies which are provided by any governmental agency
for which the Covered Person is not liable for payment will not be considered eligible. In the case of a statesponsored medical assistance program, benefits payable under this Medical Plan will be primary. Benefits
payable under this Medical Plan will also be primary for any Covered Person eligible under TRICARE (the
government sponsored program for military dependents).
(28) Growth Hormones: Expenses for growth hormone drugs or stimulants will not be considered eligible, unless
deemed Medically Necessary.
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