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EXCLUSIONS The Plan does not cover loss nor provide benefits for:

1.

Expense incurred as the result of dental treatment, except for

treatment resulting from Injury to sound, natural teeth;

2.

Services normally provided without charge by Northampton Community College Health Center, Infirmary, or Hospital, or by Health Care Providers employed by Northampton Community College;

3.

Expense incurred for eye examinations, eyeglasses, and contact lenses, including eye refractions or other Treatment for visual defects and problems, except as required as a result of a covered Injury or Sickness. "Visual defects" means any physical defect of the eye that does or can impair normal vision;

4.

Hearing examinations or hearing aids; or other Treatment for hearing defects and problems, except as required as a result of a covered Injury. "Hearing defects" means any physical defect of the ear that does or can impair normal hearing;

5.

commit a felony;

Injury due to participation in a riot or civil disorder; fighting or brawling, except in self-defense; commission of or attempt to

6.

regularly-scheduled airline;

Skydiving,

parachuting,

hang

gliding,

glider

flying,

parasailing, sail planning, bungee jumping, or flight in any type of aircraft, except while riding as a fare-paying passenger on a

7.

Injury or Sickness covered by Worker's Compensation or Employer's Liability Laws, or by any coverage provided or required by law (including, but not limited to group, group type, and individual automobile "No-Fault" coverage);

8.

Injury resulting from declared or undeclared war; or any act thereof or while serving in the armed forces of any country;

9.

Injury sustained or Sickness contracted while in service of the Armed Forces of any country. Upon the Insured Person entering the Armed Forces of any country, We will refund the unearned pro-rata premium to such Covered Person;

10.

Treatment provided in a governmental Hospital unless there is a legal obligation to pay such charges in the absence of insurance;

11.

Elective treatment and voluntary testing;

12.

Cosmetic surgery, except cosmetic surgery which the Covered Person needs as the result of an Accident which happens while he is insured under this Policy or reconstructive surgery needed as a result of a congenital disease or abnormality of a covered newborn dependent child which has resulted in a functional defect;

M a m m o g r a p h y E x a m i n a t i o n E x p e n s e B e n e f i t - I f a C o v e r e d P e r s o n r e q u i r e s a m a m m o g r a p h y e x a m , W e w i l l p a y f o r t h e f o l l o w i n g : ( a ) o n e b a s e l i n e m a m m o g r a m , a s r e c o m m e n d e d b y a P h y s i c i a n , f o r a n y w o m a n ; ( b ) a n a n n u a l s c r e e n i n g m a m m o g r a m f o r a n y w o m a n . B e n e f i t s a r e p a i d t h e s a m e a s a n y o t h e r o f f i c e v i s i t o r l a b t e s t u n d e r t h i s P l a n .

M a s t e c t o m y E x p e n s e B e n e f i t W e c o v e r c h a r g e s f o l l o w i n g a - c o v e r e d M a s t e c t o m y f o r t h e f o l l o w i n g s e r v i c e s : ( a ) R e c o n s t r u c t i o n o f t h e b r e a s t o n w h i c h t h e M a s t e c t o m y w a s p e r f o r m e d ; ( b ) S u r g e r y a n d r e c o n s t r u c t i o n o f t h e o t h e r b r e a s t t o p r o d u c e s y m m e t r i c a l a p p e a r a n c e ; ( c ) P r o s t h e s e s ; ( d ) P h y s i c a l c o m p l i c a t i o n s i n c l u d i n g l y m p h e d e m a s ; a n d ( e ) O n e M e d i c a l l y N e c e s s a r y h o m e h e a l t h c a r e v i s i t w i t h i n 4 8 h o u r s a f t e r d i s c h a r g e w h e n t h e d i s c h a r g e o c c u r s w i t h i n 4 8 h o u r s f o l l o w i n g a d m i s s i o n f o r t h e m a s t e c t o m y . S u r g e r y a n d r e c o n s t r u c t i o n w i l l b e p r o v i d e d i n a m a n n e r d e t e r m i n e d b y t h e a t t e n d i n g D o c t o r a n d t h e I n s u r e d P e r s o n t o b e a p p r o p r i a t e . W e c o v e r s u c h c h a r g e s t h e s a m e w a y W e t r e a t C o v e r e d C h a r g e s f o r a n y o t h e r S i c k n e s s .

Maternity Expense Benefit - We will pay benefits for a Covered Person's Covered Charges for maternity care, including hospital, surgical and medical care.

Newborn Infant Care - Newborn infant care is covered when the infant is confined in the Hospital and has received continuous Hospital care from the moment of birth. This does include: (a) charges for routine Doctor's examinations and tests; and (b) charges for routine procedures. This benefit also includes the necessary care and treatment of medically diagnosed congenital defects, birth abnormalities, including premature birth and routine nursery care. Covered services include charges by a certified nurse-midwife under qualified medical direction if he or she is affiliated with or practicing in conjunction with a licensed facility. We cover such charges the same way We treat Covered Charges for any other Sickness.

Nutritional Supplements - We provide coverage for the cost of nutritional supplements (formulas) for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia and homocystinuria on the same basis as any other outpatient prescription. This benefit is exempt from the annual deductible.

Preventive and Primary Care Benefits - Expenses incurred by Covered Dependent Children up to 18 years of age for Preventive and Primary Care services will be payable to the same extent as any other Covered Expenses incurred for the treatment of a covered Injury or Sickness.

1 3 W o m e n ' s P r e v e n t i v e H e a l t h S e r v i c e s B e n e f i t - W e w i l l p a y f o r a n a n n u a l g y n e c o l o g i c a l e x a m , i n c l u d i n g a p e l v i c e x a m a n d c l i n i c a l b r e a s t e x a m ; a n d a r o u t i n e P a p S m e a r . B e n e f i t s a r e p a i d t h e s a m e a s a n y o t h e r o f f i c e v i s i t o r l a b t e s t u n d e r t h i s P l a n .

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