State of Illinois - HealthLink

debriding of a nail to expose a subungual ulcer; or debridement of mycotic nails if
undertaken when the mycosis dystrophy of the toenail is causing secondary infection
and/or pain, which results or would result in marked limitation of ambulation and required
the professional skills of a physician.
40. Foot orthotics not custom-molded or fitted to the foot.
41. For personal convenience items, including but not limited to: telephone charges, television
rental, guest meals, wheelchair/van lifts, non-hospital type adjustable beds, exercise
equipment, special toilet seats, grab bars, ramps, or any other services or items determined
by the plan to be for personal convenience. Ceiling lifts and overhead lifts (portable and
semi-portable that attach to a ceiling track system) would be non-covered if prescribed to
address accessibility limitations of the home.
42. For extended care and/or hospital room and board charges for days when the bed has not
been occupied by the covered person (holding charges).
43. Occlusion guard.
44. Replacement for C-PAP machine when traveling out of the country.
45. Repair services on durable medical equipment.
46. For replacements due to negligence or loss of an item.
47. Scooters, Tedhose or paraffin bath are not covered.
48. Any condition, disability or expense resulting from or sustained while engaged in an illegal
occupation or commission of or attempted commission of an assault or a felonious act;
provided that these exclusions will not apply if the injury resulted from an act of domestic
violence or a medical condition (including both physical and/or mental health conditions).
49. Any condition, disability or expense resulting from an injury caused by participating in a
civil insurrection or riot.
50. Any charges for care or treatment provided or furnished by the United States government
or the government of any country, except to the extent that United States federal law
requires the plan to provide benefits for such care or treatment. (For treatment in VA
facilities, the law generally requires the plan to provide benefits for a covered individual
who does not have a service-connected disability.)
51. Vacuum erection devices are not covered.
52. Any charges for treatment, services or supplies related to the pregnancy (including
complications of pregnancy) or maternity care of dependent children.
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