Non-Covered Services

Chiropractic

The following list of non-covered services is not all inclusive. There may also be other services that are not covered.

1. Office visits that do not include manual spinal manipulation
2. Diagnosis for acute or chronic pain
3. Laboratory services
4. Vitamins or nutritional supplements and/or counseling
5. Treatment for a neurogenic or congenital condition that is not related to a diagnosis of subluxation
6. Medical supplies or equipment supplied or prescribed by a chiropractor
7. X-rays, other than those needed to support a diagnosis of subluxation
8. Exercise counseling, activities of daily living counseling
9. Physiotherapy modalities including, but not limited to:
   1. Ultrasound
   2. Diathermy
   3. Electrical muscle stimulation
   4. Interferential current
   5. Russian stimulation
   6. Application of hot/cold packs
   7. Massage
   8. Manual muscle stimulation
10. Chiropractic services for members age 21 years and over

Acupuncture

Non-Covered Services

Acupuncture is not covered for the following conditions. This is not an all-inclusive list of conditions for which acupuncture is not covered.

1. Weight loss
2. Drug/alcohol dependence
3. Infertility
4. Fatigue
5. Allergies/asthma
6. Acne
7. Nausea due to conditions other than surgery, pregnancy, or cancer care
8. High blood pressure
9. Cold/influenza
10. Sexual dysfunction

Other types of Oriental medicine that are not covered include, but are not limited to, the following:

1. Acupressure
2. Massage
3. Herbal supplements
4. Cupping therapy

PW_11-18_470
Updated_01/14/2026