p) Charges for drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an act of war. q ) Charges for drugs dispensed to a Member while on active duty in any armed force. r) Charges for drugs for which there is no charge. This usually means drugs furnished by the employer, labor union, or similar group in its medical department or clinic; Member’s a Hospital or clinic owned or run by any government body; or any public program, except Medicaid, paid for or sponsored by any government body. But, if a charge is made, and We are legally required to pay it, We will. s) Charges for drugs covered under Home Health Care; or Hospice Care section of the Contract t) Except as stated below, charges for drugs needed due to an on-the-job or job-related Injury or Illness; or conditions for which benefits are payable by Workers' Compensation, or similar laws. This exclusion does not apply to the following persons for Exception: whom coverage under compensation is optional unless such persons are actually workers’ covered for compensation: a self-employed person or a partner of a limited workers’ liability partnership, members of a limited liability company or partners of a partnership who actively perform services on behalf of the self-employed business, the limited liability partnership, limited liability company or the partnership. u) Compounded drugs that do not contain at least one ingredient that requires a Prescription Order. [v) Prescription Drugs or new dosage forms that are used in conjunction with a treatment or procedure that is determined to not be a Covered Service.] w) Drugs when used for cosmetic purposes. This exclusion is not applicable to Members with a medically diagnosed congenital defect or birth abnormality who have been covered under the group policy from the moment of birth. x) Drugs used solely for the purpose for weight loss. [y) Life Enhancement Drugs for the treatment of sexual dysfunction, (e.g. Viagra).] z) Prescription Drugs dispensed outside of the United States, except as required for Emergency treatment.] With respect to [Network] services and supplies, any service provided without prior Referral by the [Member's] Primary Care Physician except as specified in the Contract. Services related to Private Duty Nursing care, except as provided in the Home Health Care sections of the Contract.
p) Charges for drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an act of war. q ) Charges for drugs dispensed to a Member while on active duty in any armed force. r) Charges for drugs for which there is no charge. This usually means drugs furnished by the Member’s employer, labor union, or similar group in its medical department or clinic; a Hospital or clinic owned or run by any government body; or any public program, except Medicaid, paid for or sponsored by any government body. But, if a charge is made, and We are legally required to pay it, We will. s) Charges for drugs covered under Home Health Care; or Hospice Care section of the Contract t) Except as stated below, charges for drugs needed due to an on-the-job or job-related Injury or Illness; or conditions for which benefits are payable by Workers' Compensation, or similar laws. Exception: This exclusion does not apply to the following persons for whom coverage under workers’ compensation is optional unless such persons are actually covered for workers’ compensation: a self-employed person or a partner of a limited liability partnership, members of a limited liability company or partners of a partnership who actively perform services on behalf of the self-employed business, the limited liability partnership, limited liability company or the partnership. u) Compounded drugs that do not contain at least one ingredient that requires a Prescription Order. [v) Prescription Drugs or new dosage forms that are used in conjunction with a treatment or procedure that is determined to not be a Covered Service.] w) Drugs when used for cosmetic purposes. This exclusion is not applicable to Members with a medically diagnosed congenital defect or birth abnormality who have been covered under the group policy from the moment of birth. x) Drugs used solely for the purpose for weight loss. [y) Life Enhancement Drugs for the treatment of sexual dysfunction, (e.g. Viagra).] z) Prescription Drugs dispensed outside of the United States, except as required for Emergency treatment.] With respect to [Network] services and supplies, any service provided without prior Referral by the [Member's] Primary Care Physician except as specified in the Contract. Services related to Private Duty Nursing care, except as provided in the Home Health Care sections of the Contract.