Section 21.55.140. Care and services not covered.

   (a) A state plan may not provide benefits for charges for the following:
        (1) care for an injury or disease either
             (A) arising out of and in the course of an employment subject to a workers' compensation or similar law or where the benefit is available to be provided under a workers' compensation policy or equivalent self-insurance to a sole proprietor, business partner, or corporation officer; or
             (B) to the extent benefits are payable without regard to fault under a coverage statutorily required to be contained in a motor vehicle or other liability insurance policy or equivalent self-insurance;
        (2) treatment for cosmetic purposes other than surgery for the prompt repair of an accidental injury sustained while covered or for replacement of an anatomic structure removed during treatment of tumors;
        (3) travel, other than transportation covered under AS 21.55.110(17);
        (4) private room accommodations to the extent it is in excess of the institution's most common charge for a semiprivate room;
        (5) services or articles to the extent that the charge exceeds the reasonable charge in the locality for the service;
        (6) services or articles that are determined not to be medically necessary, except for the fabrication or placement of the prosthesis as specified in AS 21.55.110(12) and (2) of this subsection;
        (7) services or articles that are not within the scope of the license or certificate of the institution or individual rendering the services or articles;
        (8) services or articles furnished, paid for, or reimbursed directly by or under any law of a government, except as otherwise provided in this chapter;
        (9) services or articles for custodial care or designed primarily to assist an individual in the activities of daily living;
        (10) service charges that would not have been made if no insurance existed or that the covered individual is not legally obligated to pay;
        (11) eyeglasses, contact lenses, or hearing aids or the fitting of them;
        (12) dental care not specifically covered by this chapter;
        (13) services of a registered nurse who ordinarily resides in the covered individual's home, or who is a member of the covered individual's family or the family of the covered individual's spouse;
        (14) experimental procedures, except during an approved clinical trial; in this paragraph, "approved clinical trial" has the meaning given in AS 21.42.415; and
        (15) services and supplies for which the patient was not charged.
   (b)   [Repealed, Sec. 8 ch 102 SLA 2003]. 

Notes

History

(Sec. 2 ch 126 SLA 1992; am Sec. 8 ch 102 SLA 2003; am Sec. 2 ch 117 SLA 2010)