This is only a summary. Your contract will provide a detailed description of what is and is not covered.

Services not covered
After you enroll, you will receive a Membership Contract that explains exact coverage terms and conditions. This plan does not
cover all health care expenses. In general, services not provided or directed by a licensed physician are not covered. Services not
covered include, but are not limited to:

Treatment, services or procedures which are experimental,
investigative or are not medically necessary

Dental care or oral surgery, including orthognathic†

Non-rehabilitative chiropractic services

Eyeglasses, contact lenses, hearing aids and their fittings

Private-duty nursing; rest, respite and custodial care†

Cosmetic surgery†

Vocational rehabilitation; recreational or educational therapy

Sterilization reversal and artificial conception processes†

Physical, mental or substance-abuse examinations done for, or ordered by third parties†
† except as specifically described in your Membership Contract.

READ YOUR MEMBERSHIP CONTRACT CAREFULLY TO
DETERMINE WHICH EXPENSES ARE COVERED .
For details about benefits and services, call Member Services at
952-967-7540 or 866-232-1166.

This is only a summary. Your contract will provide a detailed description of what is and is not covered.