SSMC Employee Health Benefit Plan
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30. Surrogate Pregnancy. Services or Supplies related to surrogate maternity care, including but not limited
to those needed to start the Pregnancy, prenatal care, delivery or other procedures, and postnatal care or any
other related care of the Pregnancy. Benefits are available for Newborns who meet the child eligibility
requirements and are enrolled under family coverage.
31. Maternity Care for Dependent Child. Services or Supplies related to maternity care for Dependent
Children. Benefits are available for Newborns who meet the child eligibility requirements and are
enrolled under family coverage.
32. Gender Identity Disorders. Services or Supplies connected to sex change Surgery, trans-sexualism,
gender dysphoria, sexual reassignment or change, or to any treatment of gender identity disorders including
medications, implants, hormone therapy, Surgery, medical treatment, counseling or psychiatric treatment.
33. Cosmetic/Beautifying Care. Services or Supplies connected with Cosmetic Procedures or beautifying
Surgery. Reversal of elective, Cosmetic Procedures or beautifying Surgery will not be covered unless
found Medically Necessary for treatment of Illness or Injury. However, Plan excludes removal of implants
previously inserted in connection with Cosmetic Procedures, whatever the reason for removal. Exception:
Reconstructive Surgery meant to treat an infection, Injury or disease; or is incidental to or follows Surgery
resulting from a trauma, an infection or other disease of the involved part; or breast reconstruction
following covered mastectomy as specifically included in the Plan; reconstructive Surgery because of a
congenital disease or anomaly of a Dependent child that has resulted in a functional defect.
34. Complications Non-Covered Care/Removal Implants. Services or Supplies related to complications
arising from any non-covered Surgery or treatment. The removal of Prosthetic implants previously inserted
in connection with Cosmetic Procedure, whatever the reason for removal; or if not Cosmetic insertion, the
removal is not found Medically Necessary according to Plan provisions.
35. Sleep Disorders. Services or Supplies related to the treatment of sleep disorders including but not limited
to initial diagnostic studies or tests. Exception: Plan covers sleep apnea studies only when rendered as part
of the pilot program at the Sound Shore Medical Center-Sleep Center.
36. Hair Loss/Baldness. Service or Supplies related to hair loss or baldness includin g, but not limited to,
human, or artificial hair transplants, other professional care to stimulate hair growth, drugs to eliminate
baldness or stimulate hair growth, wigs and artificial hairpieces. Exception: One wig or hairpiece per
Lifetime for hair loss due to chemotherapy or radiation therapy as specifically included in the Plan.
37. Smoking Cessation/Tobacco. Services, Supplies, or drugs related to therapy for cessation of smoking or
other use of tobacco products whether or not recommended, ordered, or prescribed by a Physician.
Exception: Smoking cessation aids specifically included under Prescription Drug Expense Benefits.
38. Transportation/Travel. Services or Supplies related to transportation or travel by any means other than
by Hospital owned; professional or volunteer land ambulance even if ordered, recommended, or prescribed
by a Physician. Land Ambulance transportation when a person could have been safely transported by
other means unless ordered by a Physician, a police officer or firefighter. Land Ambulance transportation
that is not to a local Hospital, other Inpatient facility or Urgent Care Facility that can treat the patient's
condition. Land Ambulance emergency transportation from a facility unless the Covered Person is being
transferred between two facilities (due to Medical Necessity) and cannot be safely transported by any other
means. Exception: Air and Sea ambulance for conditions specifically included in the Plan.
39. Care by Relative/Household Member. Services rendered by an Immediate Relative or Household
Member. See Section X - Definitions under Immediate Relative and under Household Member.
