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limitations and This is a partial and summarized list of nitations and exclusions. Your group .,1ay have specific lirnications and exclusions not included on this list. Please check your Certificate for this complete listing. The Certificate is the docl1.1nent upon which benefit payment will be determined. Unless stated mhen'vise. no coverage will be provided for the following situations. 1. A sickness or injury which is covered under any Workers' Compensation or similar law. 2. Sickness or injury tor which the insured person is in any ..vay paid or entitled to payment or care and treannent by or tl1rollgh a government program, other than Medicaid or as otherwise provided by Texas law. 3. Education or training; 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 Drug Administration. 5. Treatment, services. supplies or surgery that is not medically necessary. 6. Purchase or fitting of hearing aids, implantable hearing devices or ad\oice on their care, unless provided by rider. TX-10434-HH 1/04 e Exclusions 7. Weekend non emergency hospital admissions. S. In-vitro fertilization. unless our In- Viero Fertilization Rider is included in the Group Policy; any. medical or surgical treannenc of in fertility; infertility evaluations; sex change services or reversal of elective sterilization. 9. Plastic, cosmetic or reconstructive surgery, unless a functional impairment is present or if required to correct a congenital defect. birth abnormality of a newborn or for breast reconstruction or as otherwise srated ill the certificate. 10. Services and supplies for dental care, treatment of teeth or periodontium or oral surgery, unless the expenses a. are medically necessary diagnostic and/ or surgical treatment of the temporomandibular Gaw or craniornandibular) joint; b. are for the surgical removal of a nllllor or lesions in the mouth; or c. are incurred in connection with an injury to sound natural teeth or jaw. except injuries resulting from biting or che'wing, sustained while the person is covered by the Group Policy. For an injury, the care and treatment must be pro\oided within the 12 mon~h period beginning on the date of the injury. Also. the insured person must remain covered R!Y..~~:mm Insured by Humana Insurance Company @2004 Humana Inc. e under the Group Policy dUring the 12 momh penod while the care and treatment is bemg received. We will not cover any treatment related to the preparation or the fitting of dentures. including demal implants. 11. Any service, supply or treatmem connected with custodial 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 treatment 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 treat medical complicat.ions due to the abordon. 15. Vision analysis. testing or orthoptic training or the purchase of eyeglasses or contact lenses. 16. Care and trearmem of complications of noncovered procedures. uruess required by sta te law.