55 18. Services, supplies or procedures related to treatment of obesity or weight reduction, except as specifically provided under the terms of the Plan, and as set forth in the SPD in the sections on Areas of Limited Coverage and Preventive and Wellness Services. 19. Charges incurred for treatment of complications from excluded procedures. 20. Charges for service s obtained on a date when the individual was not eligible to participate in the Plan, except where eligibility is provided under the extension of benefits for total disability under the terms of the Pla n, and as set forth in the SPD. 21. Drugs labeled: “Cautio n - limited by federal law to investigational use”, or experimental drugs, unless provided in connection with an approved clinical trial under the terms of the Plan, and a s set forth in the SPD. 22. Over the counter medicines and supplies, unless otherwise co vered as required under federal law . 23. Routine eye examinations, refractions, glasses, contact lenses, or the fitting of glasses or contact lenses; except for the first pair of glasses or the first pair of lenses for use after cataract surgery. 24. Dental work or dental treatment; unless it is rend ered for: (a) surgical removal of impacted teeth; (b) treatment of tumors; (c) treatment of ectodermal dysplasias (except orthodontia); or (d) repair of damage to sound natural teeth if damage is sustained in an accident and the charges are incurred within one year from the date of the accident. The term “sound natural tooth” means a tooth that: (a) is organic and formed by the natural development of the body (not manufactured); (b) has not been extensively restored; and (c) has not become extensively decay ed or i nvolved in periodontal disease. 25. Cosmetic surgery and therapies, unless resulting from an injury or illness occurring while covered under the Plan. Cosmetic surgery required by federal law will be covered. For services that are covered, precertificat ion is required , and claims must be received within one (1) year of the date of service. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self - esteem, or to treat psychological symptomatology or psych osocial complaints related to one’s appearance. The Plan covers charges made for reconstructive surgery or therapy to repair or correct severe physical deformity or disfigurement which is accompanied by functional deficit (other than abnormalities of the j aw or conditions related to TMJ disorder which is covered under another benefit under the terms of the Plan) provided that: (a) the surgery or therapy restores or improves function; (b) reconstruction is required as a result of medically necessary, non - cos metic surgery; or (c) the surgery or therapy is performed prior to age 19 and is required as a result of the congenital absence or agenesis (lack of formation or development) of a body part. Repeat or subsequent surgeries for the same condition are covered only when there is the probability of significant additional improvement as determined by the utilization review process . 26. Anti - wrinkle agents. 27. Hair growth stimulants. 28. Exercise equipment, tanning booths, whirlpools, swimming pools, saunas, spas, or h ealth club and gym memberships. 29. Charges for pre scription drug plan copayments. 30. Transsexual surgery including medical or psychological counseling and hormonal therapy in preparation for, or su bsequent to, any such surgery. 31. Coverage for the children of your children, unless such children are otherwise determined to be your qualified eligible dependents within the meaning of Section 152 of the Internal Revenue