Limitations and Exclusions
The MIT Affiliate Medical Plan covers most services provided at MIT Medical. It is not intended
to provide comprehensive coverage for all medical services. Affiliates must obtain additional coverage for services not covered under this Plan.
The benefits described in this Benefit Description, MIT Affiliate Medical Plan are limited or excluded as follows:
Acupuncture
No benefits are provided for the coverage of acupuncture.
Ambulance
No benefits are provided for the coverage of ground or air ambulance services.
Appliances and Medical Devices
No benefits are provided for the coverage of appliances or medical devices (including durable
medical equipment).
Birth Control Devices
No benefits are provided for the coverage of prescription or non-prescription birth control devices.
note: Office visits related to the provision of a birth control device or prescription are covered. See
covered services, gynecology page 10.
Cancer Therapy
No benefits are provided for the coverage of cancer therapies such as chemotherapy and/or radiation therapy.
Chiropractic Care
No benefits are provided for the coverage of chiropractic care.
Contact Lenses
No coverage for contact lense fitting or for the contact lenses. No coverage for eyeglasses. Affiliates are eligible for a discount of eyeglasses purchased at MIT Optical.Effective 9/1/2009 · Words in italics are defined in Part 2 9
Dental Care
No benefits are provided for the coverage of dental care.
Diabetic Testing Materials
No benefits are provided for the coverage of diabetic testing materials.
Emergency Room
No benefits are provided for the coverage of emergency room services or related professional fees.
Eye Exams
No benefits are provided for the coverage of routine eye exams.
Home Health Care and Hospice Care
No benefits are provided for the coverage of home health care and/or hospice care.
Inpatient Hospitalization
No benefits are provided for the coverage of inpatient hospitalizations at facilities other than the
MIT Medical Inpatient Unit. For coverage of hospitalization when admitted to the MIT Medical
Inpatient Unit, see covered services, Inpatient Hospitalizations page 9.
Maternity Care
No benefits are provided for the coverage of maternity care.
Orthotics
No benefits are provided for the coverage of orthotics.
Physical Therapy
No benefits are provided for the coverage of physical therapy.
Prescription Drugs
No benefits are provided for the coverage of prescription drugs.
Services Rendered Outside the MIT Medical Department
No benefits are provided for the coverage of services rendered outside the MIT Medical Department. When referred for services outside the MIT Medical Department, verify coverage of the
service with your insurance carrier. If covered by the MIT Affiliate Extended Insurance Plan, please
refer to the Summary Plan Description for the MIT Affiliate Extended Insurance Plan.
