◦ Isthmic spondylolysis ◦ Primary neurogenic claudication associated with stenosis ◦ Radiculopathy ◦ Spondylolisthesis greater than Grade 1 25. Drugs or medicines not covered by the plan, as described in the “Your prescription drug benefit” section, see pages 87–103 26. Drugs or medicines obtained through mail-order pharmacies located outside the U.S. 27. Educational programs, except as described under: ◦ “Diabetes Control Program” on page 47 ◦ “Diabetes education” on page 47 ◦ “Diabetes Prevention Program” on page 47 ◦ “Tobacco cessation services” on page 75 28. Electrical Neural Stimulation (ENS), which includes Transcutaneous Electrical Nerve Stimulation (TENS) units, outside of medically supervised facility settings (e.g., in-home use). 29. Email consultations or e-visits, except as described under the telemedicine benefit. 30. Equipment not primarily intended to improve a medical condition or injury, including, but not limited to: ◦ Air conditioners or air purifying systems ◦ Residential accessibility modifications ◦ Arch supports ◦ Sanitary supplies ◦ Communication aids ◦ Telephone alert systems ◦ Elevators ◦ Vision aids except when covered ◦ Exercise equipment through VSP ◦ Massage devices ◦ Whirlpools, portable whirlpool pumps, ◦ Overbed tables or sauna baths 31. Erectile or sexual dysfunction treatment with drugs or pharmaceuticals 32. Experimental or investigational services, supplies, or drugs (see page 174) 33. Extracorporeal shock wave therapy for musculoskeletal conditions 34. Eye surgery to alter the refractive character of the cornea, such as radial keratotomy, photokeratectomy, or LASIK surgery 35. Facet neurotomy for headache 36. Facet neurotomy for thoracic spine 37. Fecal microbiota transplantation for treatment of inflammatory bowel disease 38. Foot care not related to diabetes: Toenail cutting; diagnosed corns and calluses treatment; or any other maintenance-related foot care 39. Functional neuroimaging for primary degenerative dementia or mild cognitive impairment 40. Gene expression profile testing for multiple myeloma or colon cancer 41. Headaches: 108 2024 UMP CDHP (PEBB) Certificate of Coverage