(a) voluntary abortions, abortions and interrupted pregnancy that are not medically necessary;

(b) elective cosmetic surgery, except as provided for in the Women’s Health Act;

(c) custodial care, domiciliary care, private duty nursing services or rest cures, except as provided for in hospices;

(d) personal comfort or convenience items;

(e) any service not medically necessary for the diagnosis or treatment of a disease, injury or condition;

(f) non-emergency use of Emergency Room;

(g) over-the-counter drugs not listed in the Drug
Formulary;

(h) drugs not listed in the Drug Formulary, unless otherwise provided in this Act;

(i) experimental drugs, experimental and palliative treatments or procedures, unless approved by the Administrator;

(j) fertility procedures, reversal of sterilization and services related to artificial conception;

80

COL 8/23/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH 2 DIVISION OF PUBLIC WELFARE

(k) treatment, services and supplies related to sexual dysfunction;

(l) trans-sexual surgery and related services; (m) motorized limbs;
(n) services for any incarcerated person;

(o) care or services furnished by immediate relatives or members of the patient’s household, unless rendered as a duly licensed medical practitioner employed by a health care Provider;

(p) health cares services, which are provided and reimbursed by other local or Federal programs, MIP is the payer of last resort;

(q) speech and language therapy;

(r) tissue and organ transplants, and any other related hospital, surgical drug, radiology, laboratory or other medical services before, during and after transplant;

(s) treatment and services for artificial weight reduction, including gastric bypass stapling or reversal, or liposuction;

(t) treatment by any method for temporomandibular joint disorders, including, but not limited to, crowning, wiring or repositioning of teeth;

(u) treatment for injuries sustained in the commission of an illegal or criminal act, including driving under the influence;

(v) any work-related injury, subject to compensation pursuant to the Workers Compensation Law;

(w) care for military service connected disabilities to which the patient is legally entitled to government benefits or care;

(x) orthopedic footwear, unless attached to an artificial foot or unless attached as a permanent part of a leg brace; and

(y) benefits and services not specifically listed as covered.

81

COL 8/23/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH 2 DIVISION OF PUBLIC WELFARE

SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003).