Part 6 – Limitations and Exclusions (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 74 organ (or tissue) or stem cells and the related medically necessary services and tests that are required to perform the transplant itself.  A service or supply that you received when you were not enrolled in this health plan. (The only exception is for routine nursery charges that are furnished during a covered maternity admission and certain other newborn services.)  A service or supply that is furnished to all patients due to a facility’s routine admission requirements.  A service or supply that is related to achieving pregnancy through a surrogate (gestational carrier).  Refractive eye surgery for conditions that can be corrected by means other than surgery. This type of surgery includes radial keratotomy.  Whole blood; packed red blood cells; blood donor fees; and blood storage fees.  A health care provider’s charge for shipping and handling, taxes, or travel expenses.  A health care provider’s charge to file a claim for you. Also, a health care provider’s charge to transcribe or copy your medical records.  A separate fee for services furnished by: interns; residents; fellows; or other physicians who are salaried employees of the hospital or other facility.  Expenses that you have when you choose to stay in a hospital or another health care facility beyond the discharge time that is determined by Blue Cross Blue Shield HMO Blue.  Costs related to activities such as fitness or weight loss programs. Even though this health plan does not include health benefits for these costs, reimbursement for participation in qualified wellness programs may be available under a separate Wellness Participation Program rider. If this is the case, refer to your rider for information about qualified wellness program reimbursement.  A service or supply that is either not legal or not legal in the location where performed or provided. Personal Comfort Items No benefits are provided for items or services that are furnished for your personal care or for your convenience or for the convenience of your family. Some examples of non-covered items or services are: telephones; radios; televisions; and personal care services. Private Room Charges While you are an inpatient, this health plan covers room and board based on the semiprivate room rate. If a private room is used, you must pay all costs that are more than the semiprivate room rate. Services and Supplies Furnished After Termination Date No benefits are provided for services and supplies that are furnished after your termination date in this health plan unless otherwise required by law. Exception for inpatient admissions prior to January 1, 2025: For inpatient admissions that begin prior to January 1, 2025, this health plan will continue to provide coverage for inpatient covered services, but only if you are receiving covered inpatient care on your termination date. In this case, coverage will continue to be provided until all the benefits allowed by your health plan have been used up or the date of discharge, whichever comes first. But, this exception does not apply if your coverage in this health plan is canceled for misrepresentation or fraud.