Exclusions List
EUTF Supplemental Medical & Prescription Drug Plan
Exclusions List: (Download Document)
This EUTF supplemental plan does not pay for taxes, your primary group health plan’s deductible or enrollment fees, services not specified as Covered Expenses, and services or benefits not paid by your primary group health plan. Any charges after reaching the plan maximum in your primary group health plan are excluded from reimbursement. Plan exclusions include but are not limited to the following:
Acupuncture |
Hair loss |
Aromatherapy |
Hearing aids |
Behavior testing |
Homemaker services |
Benefits not covered by your primary group health plan |
Hypnotherapy |
Biofeedback |
Massage therapy |
Bionic devices |
Naturopathy |
Blood or blood products |
Oral travel immunizations/medications |
Charges for donor sperm or ova |
Over the counter drugs |
Charges in excess of the eligible/allowable rates negotiated between any group health/medical plan and the provider or entity providing the service to the employee-beneficiary |
Personal convenience items |
Chiropractic |
Photo-refractive keratectomy |
Complications of a non-covered procedure |
Physical Examinations Related to• Employment• Insurance• Licensing• Court-order such as parole or probation |
Cosmetic surgery |
Prescription drug charges in excess of the benefit maximum or annual prescription drug benefit maximum |
Cost of storing or processing sperm |
Oral travel immunizations/medications |
Counseling for Bereavement, Genetic, Sexual Identification |
Provider is an Immediate Family Member |
Custodial care |
Radial keratotomy |
Dental Care Services |
Rest cure |
Disposable take home supplies |
Reversal of voluntary sterilization |
Expenses or care for cosmetic surgery performed mainly to change a person’s appearance |
Routine foot care (unless medically necessary) |
Expenses or care that are not medically necessary or not prescribed by a licensed physician |
Self-help or self-cure |
Expenses exceeding the maximum benefit amount allowed under this plan or your primary group health plan. |
Services for which the patient has no responsibility to pay due to:• Military or service-related condition• Workers’ Compensation liability• Automobile related condition |
Expenses incurred after your termination date of this plan |
Services not medically necessary |
Expenses incurred prior to your coverage effective date of this plan |
Sleep therapy |
Expenses not listed (eligible) under Covered Expenses in this plan. |
Stand-by time |
Expenses paid or payable under any other source including insurance plan/policy |
Transplants• Services for or transportation of a living donor• Mechanical or non-human organs• Organ purchase |
Experimental or investigational services |
Travel and lodging cost |
Eye exams, eye exercises (Routine) |
Weight reduction programs |
Eyeglasses; corrective lenses |
Wigs |
Fertility/Infertility |
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Gender reassignment |
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Government covered services (Medicaid, Medicare, QUEST) |
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Group health plan deductibles that you have to satisfy in your primary group health plan |