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limitations and This is a partial and summarized list of nitations and exclusions. Your group _.lay have specific limitations and exclusions not included on this list. Please check your Certificate for this complete listing. The Certificate is the document upon which benefit payment will be determined. Unless st:lted otherwise. no coverage will be provided for tht: following situations. I. A sickness or injury which is covered under any Workers' Compensation or similar law. 2. Sickness or injury for which the 1l1sured person is in any way paid or entitled to paynllmt or care and treatment by or through a government program, other than Medicaid or as otherwise provided by Texas law. 3. Education or mining; medical services provided by the insured person's parent, spouse, brother, sister or child. 4. Investigational or experimental drugs or substances not approved by Humana or by the Food and Dnlg AdminiStl"ation. 5. Treatment, services. supplies or surgery that is not medically necessary. 6. Purchase or fitting of hearing aids, . implantable hearing devices or advice on their care, unless provided by rider. ( TX-23441-HH 1/04 e Exclusions 7. Weekend non emergency hospital admissions. 8. In-vin-o fertilization. unless our In- Vin-o Fercilization Rider is included in the Group Policy; any medical or surgical treatment of infertility; infertility evaluations; sex change services or reversal of elective steriliz,,1tion. 9. Plastic. cosmetic or reconstructive surgery. unless a nmcoonal impairment is present or if required to correct a congenital defect. birth abnormality of a newborn or for breasr reconstruction or as otherwise stated in the certificate. 10. Services and supplies for dental care, treatment of teeth or periodontium or ora] surgt:ry. unless the expenses a. are medically necessary diagnostic and/or surgical treamlent of the temporomandibular Gaw or craniomandibu]ar) joint; b. are for the surgical removal of a tumor or lesions in the mouth; or c. are incurred in connection \vith an injury to sound natural teeth or jaw, except injuries resulting tram biting or chewing, sustained while the person is covered by the Group Policy. For an injury, the care and treatment must be pl"Ovided within the 12 month period beginning on the date of the injury. Also. the insu.red person must remain covered }~!2..~~;mm Insured by Humana Insurance Company @2004 Humana Inc. . under the Group Policy during the 12 month period while the care and treatment is being received. We wiII not cover any treatment rebted to the preparation or the fitting of dentures. including dental implants. 11. AllY service. supply or treannent connected witl1 custodia] care. 12. Sickness or injury caused by the insured person's: a. engaging in an illegal occupation: or b. commission of or an attempt to commit a criminal act. 13. Any tream1enc to reduce obesity, including, but not limited to. surgical procedures. 14. Elective abortion unless: a. the physician certifies in writing that the pregnancy would endanger the life of the mother: or b. the pregnancy is a result of rape or incest; or c. the services are received to trear medical complications due to the abortion. 15. Vision analysis, testing or orthoptic training or the purchase of eyeglasses or contact lenses. 16. Care and treatment of complications of lloncovered procedures. unless required by state law.