124. Upright magnetic resonance imaging (uMRI), also known as “positional,” “weight-bearing” (partial or full), or “axial loading” 125. Vagal nerve stimulation (VNS) for treatment-resistant depression 126. Vagal nerve stimulation (VNS) for the treatment of depression (does not include or apply to support of previously implanted VNS) 127. Vision hardware replacements: ◦ The plan does not cover the replacement of any lost, stolen or broken lenses and/or frames. 128. Vision, routine: ◦ Certain contact lens expenses: • Artistically-painted or nonprescription contact lenses; • Contact lens modification, polishing or cleaning; • Refitting of contact lenses after the initial (90-day) fitting period; • Additional office visits associated with contact lens pathology; and • Contact lens insurance policies or service agreements. ◦ Corrective vision treatment of an experimental or investigational nature • The VSP benefits do not cover investigational or experimental treatments or procedures (health interventions), services, supplies, and accommodations provided in connection with health interventions. ◦ Lens enhancements: The VSP benefits do not cover lens enhancements, including, but not limited to: • Anti-reflective coating; • Color coating; • Mirror coating; • Scratch-resistant coating;* • Blended lenses; • Cosmetic lenses; • Laminated lenses; • Oversize lenses; • Premium and custom progressive multifocal lenses; • Photochromic lenses; • Tinted lenses, except Pink #1 and Pink #2; • UV (ultraviolet) protected lenses;* and • Impact-resistant coating.* *These lens enhancements are covered for children under age 19. Impact-resistant coating is also covered for dependent children age 19 or older. ◦ Medical or surgical treatment of the eyes 129. Vision services and supplies: ◦ The plan does not cover services or supplies that are not medically necessary: • Plano lenses (less than a ± .50 diopter power). • Two pair of glasses instead of bifocals. • Services and/or materials not described as covered under this vision benefit. 130. Vitamin D screening and testing as part of routine screening 131. Weight control, weight loss, and obesity treatment: ◦ Non-surgical: Any program, drugs, services, or supplies for weight control, weight loss, or obesity treatment. Exercise or diet programs (formal or informal), exercise equipment, or travel expenses 2024 UMP CDHP (PEBB) Certificate of Coverage 115