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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 stated othen\oise. no coverage will be provided for the following simatiollS. 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 way paid or entitled to payment or care and treatment by or through a government program, other than Medicaid or as othe.rwise 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 advice 011 their care, unless provided by rider. ( TX-10434-HH 1/04 e Exclusions 7. Weekend nonemergency hospital admissions. 8. In-vitro fertilization. unless our In-Vim) Fertilization Rider is included in the GI'OUP Policy; any medical or surgical treatmen r of infertility; 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 correcr a congenital defect. birth abnormality of a newborn or for breast reconstruction or as otherwise scared in the certificate. 10. Services and supplies for dental care, treatment of teeth or periodontium or oral surgery, unless the e~l'enses a. are medically necessary diagnostic and/or surgical treatment of the temporomandibular Gaw or craniomandibular) joint; b. are for the surgical removal of a. nmlOr 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 chewing, sustained while the person is covered by the Group Policy. For an. injury, the care and treaonent must be provided within the 12 month period beginning on the date of the injury. Also. the insured person must remain covered '" Ff2...~~;~ Insured by Humana Insurance Company @2004 Humana Inc. e under the Group Policy durin.g the 12 month period while the care and treatment is being received. We will not cover any treaonent related to the preparation or the fitting of deumres. including dental implants. 11. Any senri.ce, supply or treatment connected with custodial care. 12. Sickness or injury caused by the insured persons: 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 tllat 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 complications due to the a borrion. 15. Vision analysis. testing or orthoptic training or the purchase of eyeglasses or contact lenses. 16, Care and treatment of complications of noncovered procedures. unless required by state law.