Exclusions and Limitations: Medical Care that is Not Covered by SHIP

The Student Health Insurance Plan does not cover the following:

• Unauthorized Services: Services not approved by the Student Health Insurance Office, except: routine and diagnostic mammogram examinations to detect breast cancer, acupuncture, non-surgical podiatry, chiropractic services and prescription drugs.
• Preventive/Elective Services: Testing, treatment, or services for any condition in the absence of Sickness or Injury except for (1) screening mammograms, (2) cervical cancer screening (PAP smears), (3) prescription birth control, (4) certain adult immunizations.
• Obesity/Weight Reduction: Services primarily for weight reduction or treatment of obesity. Treatment of morbid obesity may be a covered benefit, subject to verification of diagnosis and utilization review for medical appropriateness and necessity following Anthem Blue Cross Medical Review criteria.
• Nutrition Consultation: Except for diabetes education programs covered as medical office visits.
• Cosmetic Surgery: Except reconstructive surgery as a result of accidental Injury or Sickness that occurs while eligible for SHIP benefits.
• Nasal Surgery: Except medically-necessary surgical treatment for acute sinusitis, or due to a medically documented accidental Injury that occurs while eligible for SHIP benefits.
• Intercollegiate Sports Injuries: Treatment of Injury sustained while participating in, practicing or conditioning for, or traveling in conjunction with, any intercollegiate sport, contest or competition, or any University-sponsored (including intramural) program in the martial arts.
• Workers' Compensation Services: Treatment of any Sickness or Injury eligible for compensation under any Workers' Compensation or Occupational Disease Law.
• Crime, Nuclear Energy: Conditions that result from: (1) your commission of or attempt to commit a felony; or (2) any release of nuclear energy, whether or not the result of war, when government funds are available for treatment of illness or injury arising from such release of nuclear energy.
• Organ and Tissue Transplants
• Infertility Treatment: Any services or supplies furnished in connection with the diagnosis and treatment of infertility, including, but not limited to, diagnostic tests, medication, surgery, artificial insemination, sterilization reversal, in vitro fertilization and gamete intrafallopian transfer. Infertility is:
  1. the presence of a condition recognized by a Physician as the cause of infertility or
  2. the inability to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations without contraception.
• Dental Services or Supplies: Braces, orthodontic appliances, and orthodontic services. Dental plates, bridges, crowns, caps or other dental prostheses, dental services, extraction of teeth or treatment to the teeth or gums. Cosmetic dental surgery or other services for beautification.
• Speech Disorders: Services primarily for correction of speech disorders, including, but not limited to stuttering or stammering.
• Hearing Aids: Including exams for fitting, except as required to correct damage caused by an Injury which occurs while the patient is covered by SHIP.
• Services Performed by a Family Member: All medical and psychological treatment, or services performed by any member of your immediate family.
• Experimental, or Unnecessary Medical Treatment/Testing: Includes medical services that are not medically necessary or that do not conform with medical standards of practice within the community. Also services and supplies in connection with experimental or investigational treatment.
• Sex Transformation: Procedures or treatments to change characteristics of the body to those of the opposite sex.
• Sterilization Reversal: Reversal of sterilization.
• Orthopedic Supplies: Orthopedic shoes (except when joined to braces) or shoe inserts.
• Air Conditioners: Air purifiers, air conditioners or humidifiers.
• Exercise Equipment: Exercise equipment, or any charges for activities, instrumentalities, or facilities normally intended or used for developing or maintaining physical fitness, including but not limited to, charges from a physical fitness instructor, health club or gym, even if ordered by a physician.
• Personal Items: Any supplies for comfort, hygiene or beautification.
• Telephone and Facsimile Machine Consultations: Consultations provided by telephone or facsimile machine.
• Routine Exams or Tests: Routine physical exams or tests which do not directly treat an actual illness, injury or condition, including those required by employment, government authority and travel.
• Unstated Treatment, Services and Supplies: SHIP will not pay benefits for any treatment, service, or supply that has not been listed herein as a covered service or item, even if it has not been specifically identified as an "excluded" item.

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