Care Furnished Without Charge Payment will not be made for any care if the care is furnished or would normally be furnished to you without charge. You are not covered for services rendered for which no legally enforceable charge is incurred. Unless your coverage specifically includes chiropractic care, you are not covered for care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment, or subluxation of or in the vertebral column. You are not covered for services related to bed rest, rest cures, convalescent care, or custodial care. You are not covered for sanitarium care.
Custodial care refers to care primarily to help with the activities of daily living.
For example, help in walking or getting in or out of bed, dressing, eating, or taking medication are all considered custodial care. The guidelines used by Medicare will be used to determine whether care is custodial in nature. Unless specifically provided otherwise in your Benefits Chart, payment will not be made for services in connection with elective cosmetic surgery or treatment which is primarily intended to improve your appearance. However, payment will be made for services in connection with reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection, or other diseases of the part of the body involved. Payment will also be made for reconstructive surgery performed due to congenital disease or anomaly of a covered child which has resulted in a functional defect.