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••~~r~ ~~~~. ~~ ~,~C un i vers i.ty of Oregon Hospi tal ) ror; <br />any other hospital., surgical, medical or .o <br />,' char e is r~services for which no <br />9 , or which none of..the indiv.i ; insured under the Pl"an <br />. is legally~igated to a . ~ ~ <br />. Py <br />5. Charges for services and supplies which are~;not necessary for_treatment <br />of the injury or disease or are not ordered~by the attendi;ng physician. <br />6. Charges for services payeble.under Part A or B of Title.l8~or 19 of the <br />Social Security ,Act or. any amendments thereto commonly known as <br />'Medicare'. ' , <br />7. Charges for services and supplies for treatment of drug abuse. <br />8. Hospital charges for personal services .su,ch as radio, telephone, <br />television or personal items not required .in the-treatment of illness <br />or injury. . <br />9. Elective abortions, treattnent for sterility. <br />10. Work-related conditions: Services:or supplies for treatment of illness <br />or injury arising out of or in the course .of employment for wages <br />whether or not the cost of the service or supply is covered-~under <br />Workers' Compensation. The only exception. would be if inember or <br />member's insured dependent is exempt from state or Federal'Workers' <br />Compensation. <br />11. Injuries as a result of participation in insurrection or war, declared <br />or undeclared, injuries sustained. by the ~member in the act of <br />committing a crime or while involved in an illegal occupation. <br />12. Charges incurred in connection. with enlargement or reduction of <br />breasts, ileal bypass or any surgery for weight reduction, change of <br />sex of male or female, lipectomy, or other changes of anatomy not <br />connected with illness or injury. Serv.ices or supplies related to sex <br />transformation or sexual dysfunction or inadequacies. <br />13. There shall be no coverage for~marriage counseling, milieu therapy, <br />occupational or speech therapy..- _ : <br />14. Charges for treatment of injuries or illness incurred by attempted <br />suicide. <br />15. Benefits for procedures using body .scanners will be provided only for <br />medically appropriate procedures using body `scanners sanctioned by the <br />appropriate Health Systems Agency and the State Health Planning and <br />Development Agency. ; <br />16. Services or supplies for any condition for which pa'yment, treatment or <br />care may be obtained in whole or in part;upon.timely application under <br />any city, county, state or federal law. - <br />9 .. . ~ <br />(9) 1/87 <br />