54 Exclusions The Plan does not cover charges or treatments of all Injuries or illness, or pay expenses for all medications. Excluded benefits and services include, but are not limited to, the following: 1. Treatment of an illness for which benefits are payable under any Workers’ Compensat ion law, or treatment of an injury which arises out of, or in the course of, employment. 2. Treatment of an illness or injury that results from, or arises out of, any past or present employment or occupat ion for compensation or profit. 3. Injury or illness that results from an act of declared or undeclared war, the participant’s commission of a crime, or non - therapeutic re lease of nuclear energy. 4. A charge, or part of a charge, that the participant is not obligated to pay, or for which you would not have been bill ed except for the fact that the individ ual was covered under the Plan. 5. Services, supplies, or treatments provided by: (a) a person who ordinarily lives in the participant’s home, or (b) a spouse, child, parent, or sibling of the participant or of the parti cipant’s spouse . 6. Experimental, investigational, or unproven services, treatments, or devices, unless provided during an approved clinical trial as set forth in the SPD. Experimental, investigational, and unproven services, treatments, or devices are health care technologies, supplies, treatments, procedures, drug therapies, or devices that are not demonstrated through existing peer - reviewed, evidence based, scientific literature to be safe and effective for treating and diagnosing the condition or sickness for which its use is proposed, or is not approved by the FDA or other appropriate regulatory agency to be lawfully marketed for the proposed use. 7. Charges for services, supplies, or treatments that are furnished, paid for, or otherwise provided as a result of past or present service in the armed forces of a government, excep t as otherwise provided by law. 8. Charges for services, supplies, or treatments that are furnished, paid for, or otherwise provided by any local, state, or federal government agency, progra m, or institutions, unless otherwise provided by law. 9. Services, supplies, or treatments that are not medically necessary . 10. Services, supplies, or treatments that are not ordered by a physician or by an Allied Health Professional who is practicing within t h e scope of his or her license. 11. Charges that are not necessary for the treatment of an illness or injury except as otherwise provided in the SPD. 12. Custodial Care. 13. Services primarily for rest, domicili ary care, or convalescent care. 14. Charges that exceed the Us ual, Customary , and Reasonable charge amount. 15. Expenses for any services, supplies, or treatments that are unreasonably priced, or are not reasonably necessary for the illness or injury being treated. 16. Charges incurred for reversal of sterilization (benefits are payable for sterilization). 17. Charges incurred for treatment of infertility, including infertility drugs, surgical or medical treatment programs, impregnation techniques, such as artificial insemination, in vitro fertilization and development of an embr yo, implantation of an embryo developed in vitro, and variations of these procedures. Cryopreservation of donor sperm and eggs a re also excluded from coverage.