MMC Benefits Handbook
All Other Exclusions
  • Health services and supplies that do not meet the definition of a Covered Service
  • Physical, psychiatric or psychological exams, testing, vaccinations, immunizations or treatments that are otherwise covered under the Plan when:
    • Required solely for purposes of career, education, sports or camp, travel, employment, insurance, marriage or adoption
    • Related to judicial or administrative proceedings or orders
    • Conducted for purposes of medical research
    • Required to obtain or maintain a license of any type
  • Treatment for insomnia dementia and neurological disorders and other conditions without a known basis (e.g., Treatment for insomnia, nightmare or hypersomnolence without medical, mental health or other sleep disorder co-morbidity, unspecified sleep-wake or hypersomnolence disorder, unspecified neurocognitive disorder, factitious disorder)
  • Health services received after the date your coverage under the Plan ends, including health services for medical conditions arising before the date your coverage under the Plan ends
  • Health services for which you have no legal responsibility to pay, or for which a charge would not ordinarily be made in the absence of coverage under the Plan
  • In the event that a non-network provider waives copayments and/or the annual deductible for a particular health service, no benefits are provided for the health service for which the copayments and/or annual deductible are waived
  • Charges in excess of eligible expense or in excess of any specified limitation
  • Custodial care
  • Domiciliary care (e.g., group living arrangements)
  • Respite care
  • Rest cures
  • Treatment of benign gynecomastia (abnormal breast enlargement in males)
  • Medical and surgical treatment of excessive sweating (hyperhidrosis)
  • Medical and surgical treatment for snoring, except when provided as a part of treatment for documented obstructive sleep apnea
  • Appliances for snoring
  • Any charges for missed appointments, room or facility reservations, completion of claim forms or record processing
  • Any charges higher than the reasonable and customary charge
  • Any charge for services, supplies or equipment advertised by the provider as free
  • Any charges by a provider sanctioned under a federal program for reason of fraud, abuse or medical competency
  • Any charges prohibited by federal anti-kickback or self-referral statues
  • Any additional charges submitted after payment has been made and your account balance is zero
  • Any charges by a resident in a teaching hospital where a faculty physician did not supervise services
  • Outpatient rehabilitation services, spinal treatment or supplies including, but not limited to spinal manipulations by a chiropractor or other doctor, for the treatment of a condition which ceases to be therapeutic
  • Spinal treatment, including chiropractic and osteopathic manipulative treatment, to treat an illness, such as asthma or allergies
  • Speech therapy to treat stuttering, stammering, or other articulation disorders.