Health Plans for Individuals and Families do not provide benefits for:

• Charges incurred due to a pre-existing condition.
• Illness or injury caused by war, commission of crime, attempted suicide, influence of illegal substance.
• Routine hearing care, routine vision care, vision therapy, surgery to correct vision, routine foot care, or foot orthotics.
• Cosmetic services.
• Charges by a health care practitioner or medical provider who is an immediate family member including, you, your spouse, your children, siblings, parents, their spouses and legal guardians.
• Custodial care.
• Charges reimbursable by Medicare, Workers' Compensation or automobile carriers.
• Growth hormone stimulation treatment.
• Dental care not related to a dental injury.
• Any treatment for correction of malocclusion, protrusion, hypoplasia or hyperplasia of the jaws.
• Charges for educational testing or training, vocational or work hardening programs, transitional living, or services provided through a school system.
• Diagnosis and treatment of infertility.
• Maternity and routine nursery charges unless you choose the maternity option.
• Pregnancy, maternity and other expenses related to surrogate pregnancy.
• Genetic testing, counseling and services.
• Charges for sex transformation, or treatment of sexual dysfunction or inadequacy or to restore or enhance sexual performance or desire.
• Over-the-counter products.
• Contraceptive drugs or devices.
• Treatment of "quality of life" or "lifestyle" concerns, including but not limited to smoking cessation; obesity; hair loss; sexual function, dysfunction, inadequacy or desire; or cognitive enhancement.
• Treatment used to improve memory or to slow the normal process of aging.
• Telemedicine (including but not limited to treatment rendered through the use of interactive audio, video or other electronic media).

Preauthorization
When you need inpatient treatment or certain outpatient procedures, obtain preauthorization to avoid a penalty of 25% of the charge, up to $1,000. There is no coverage for transplants which are not authorized.

Conversion Privilege
A spouse or dependent who is no longer eligible for coverage under this plan may obtain a similar plan without evidence of insurability.

Waiting Periods on Certain Conditions
Benefits for certain conditions are payable after the waiting period listed here: tonsils/adenoids, 3 months; sterilization, 12 months; hernia (except strangulated or incarcerated), 6 months; bunionectomy, 6 months; varicose veins, 6 months; hemorrhoids, 6 months. The waiting period is waived when this plan is replacing other similar in-force coverage.

Pre-existing Conditions
A pre-existing condition is an illness or injury and any related complications for which, during the 12-month period immediately prior to your effective date, you received medical treatment, diagnosis, consultation or prescription drugs; or which produced symptoms or was capable of being diagnosed. Health Plans for Individuals and Families do not pay benefits for charges incurred due to a pre-existing condition, as defined in the contract, until you have been continuously insured under such a plan for 12 months. After this 12-month period, benefits will be paid for a pre-existing condition, unless the condition has been specifically excluded from coverage.

This brochure contains a general summary of benefits, exclusions and limitations. Please refer to the certificate of coverage for the actual terms and conditions. In the event there are discrepancies with the information given here, the terms and conditions of the coverage documents will govern.