Treatment that is in violation of the Statement of Beliefs and Ethics including illness or injury arising from grossly negligent acts, use of illegal drugs, abuse of alcohol, or any illegal activity, whether or not an arrest is made, charges are filed, or a conviction results.
- Cosmetic Surgeries with exceptions:
- Breast reconstruction after cancer
- Medically necessary breast reduction
- Reconstructive surgery from any injury
- Cleft palate
- Infertility treatment
- In-vitro fertilization
- Genetic testing
- Inpatient psychological treatment
- Medical supplies (except in FlexShare)
- Non-medical expenses
- Gym memberships (except in FlexShare)
- Bills related to an event while on active duty.
- Bills that should be covered by Worker’s Compensation Insurance
- Any injury or illness arising from any illegal activity.
- Charges outside the US if they traveled to that location for the sole purpose of receiving treatment.
- Any charges where a Third-Party is responsible.
- Charges not submitted within the 12-month timeline from the date of service.
- Charges for the release of medical records
- Charges for anything relating to transsexualism, gender dysphoria, sexual reassignment or change, including medications.
- Charges for travel or accommodations to pursue treatment at a non-local site of care unless approved by the ministry on a case-by-case basis.
- Drug/alcohol treatment
- Procedures or surgery that is not medically necessary
- Prophylactic (treatment intended to prevent disease) and preventive surgery without personal history of diagnosis and a doctor’s recommendation.
- Nutrition Services, (except in FlexShare)
- Experimental Treatment
- Psychotropic medication
- Birth control
- Abortion
- Complications related to ineligible procedures, conditions, and diagnoses except pre-existing maternity. This includes any future-related needs.
- Transportation to appointments
- Additional wellness visits beyond the one allowed per membership year, (except in FlexShare).