For Retirees Not Eligible for U.S. Medicare
Indemnity medical benefits are not payable for any of the following listed items.

1. Services or supplies subject to the General Exclusions applicable to all benefits.
2. Charges for educational services or supplies. A charge for a service or supply is not covered to the extent that it is determined by the Trust’s medical consultants to be educational. In the case of a hospital stay, the length of the stay and hospital services and supplies are not covered to the extent that they are determined to be allocable to scholastic education or vocational training of the patient.
3. Services related to vision: (a) exams to determine the need for (or changes of) eyeglasses or lenses of any type; (b) eyeglasses or lenses of any type except initial replacements for loss of the natural lens; or (c) eye surgery such as radial keratotomy when the primary purpose is to correct myopia (near-sightedness), hyperopia (far-sightedness) or astigmatism (blurring).
4. Prescription drugs. If a prescription drug is specifically excluded under the managed prescription drug program, and is determined to be medically necessary, it may be covered under the Medical Plan.
5. Examinations for the fitting and cost of hearing aids.
6. Charges for routine or preventive care not necessary to the treatment of any injury or illness. This includes well-child care and check-ups.
7. Expenses for doctor’s services or X-ray exams involving teeth, the tissue or structure around them, the alveolar process or the gums. This applies to conditions requiring treatment of parts of the body other than the mouth such as treatment of Temporomandibular Joint Disorders (TMJD) or malocclusion involving joints or muscles by methods including, but not limited to, crowning, wiring or repositioning teeth. This exclusion does not apply to charges made for the treatment or removal of a malignant tumor, or for dental services received within 12 months after an accident. Covered treatment includes those by a doctor, dentist or dental surgeon of injuries to natural teeth, including replacement of such teeth, and related Xrays.
8. Treatment of: (a) weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, except open cutting operations; or (b) corns, calluses or toenails, except removing nail roots and care prescribed by an M.D. or D.O. treating metabolic or peripheral-vascular disease.
9. Charges for non-surgical treatment of the spine and supporting structure (including, but not limited to, physical therapy and chiropractic services), in excess of 30 treatments per calendar year.
10. Charges relating to pregnancy of a covered dependent child.
11. Expenses related to infer tility, including invitro-fertilization, ar tificial insemination or embryo transfer procedures, microinjections, zona drilling, or other artificial means of conception, consecutive follicular ultrasounds, cycle therapy and corresponding laboratory tests when associated with artificial means of conception for either a covered person or surrogate as a donor or a recipient.
12. Expenses in connection with conception, pregnancy or delivery in connection with a surrogacy arrangement.
13. Expenses in connection with sex change surgery or complications resulting from such surgery.
14. Charges made in connection with the treatment of mental health or chemical dependency.
15. Expenses in connection with cosmetic surgery, including treatment of complications resulting from such surgery.
16. Expenses applied toward satisfaction of the deductible.