Part 6 – Limitations and Exclusions (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 72 Dental Care Except as described otherwise in this Subscriber Certificate or your Schedule of Benefits, no benefits are provided for treatment that Blue Cross Blue Shield HMO Blue determines to be for dental care. This is the case even when the dental condition is related to or caused by a medical condition or medical treatment. There is one exception. This health plan will cover facility charges when you have a serious medical condition that requires that you be admitted to a hospital as an inpatient or to a surgical day care unit of a hospital or to an ambulatory surgical facility in order for your dental care to be safely performed. Some examples of serious medical conditions are: hemophilia; and heart disease. Educational Testing and Evaluations No benefits are provided for exams, evaluations, or services that are performed solely for educational or developmental purposes. The only exceptions are for: covered early intervention services; treatment of mental conditions for enrolled dependents who are under age 19; and covered services to diagnose and/or treat speech, hearing, and language disorders. (See Part 5.) Exams or Treatment Required by a Third Party No benefits are provided for physical, psychiatric, and psychological exams or treatments and related services that are required by third parties. Some examples of non-covered services are: exams and tests that are required for recreational activities, employment, insurance, and school; and court-ordered exams and services, except when they are medically necessary services. (But, certain exams may be covered when they are furnished as part of a covered routine physical exam. See Part 5.) Experimental Services and Procedures This health plan provides coverage only for covered services that are furnished according to Blue Cross Blue Shield HMO Blue medical technology assessment criteria. No benefits are provided for health care charges that are received for or related to care that Blue Cross Blue Shield HMO Blue considers experimental services or procedures. The fact that a treatment is offered as a last resort does not mean that this health plan will cover it. There are two exceptions. As required by law, this health plan will cover:  One or more stem cell (“bone marrow”) transplants for a member who has been diagnosed with breast cancer that has spread. The member must meet the eligibility standards that have been set by the Massachusetts Department of Public Health.  Certain drugs that are used on an off-label basis. Some examples of these drugs are: drugs used to treat cancer; drugs used to treat HIV/AIDS; and, long-term antibiotic therapy drugs for the treatment of Lyme disease, if the drug has been approved by the U.S. Food and Drug Administration (FDA) to treat other infectious diseases. (See “Home Health Care” for your coverage for long-term antibiotic therapy treatment of Lyme disease.) Eyewear No benefits are provided for eyeglasses and contact lenses, except as described as a covered service in Part 5 or in your Schedule of Benefits and/or riders. Medical Devices, Appliances, Materials, and Supplies No benefits are provided for medical devices, appliances, materials, and supplies, except as described otherwise in Part 5. Some examples of non-covered items are:  Devices such as: air conditioners; air purifiers; arch supports; bath seats; bed pans; bath tub grip bars; chair lifts; computerized communication devices (except for those that are described in Part 5);