(1) In addition to any exclusions noted elsewhere in these rules, the following services are not covered benefits:
(a) experimental services or services generally regarded by the medical profession as unacceptable treatment;
(b) custodial care;
(c) personal comfort, hygiene, and convenience items which are not primarily medical in nature;
(d) whirlpools;
(e) organ and tissue transplants;
(f) treatment for obesity;
(g) acupuncture;
(h) biofeedback and neurofeedback;
(i) chiropractic services;
(j) cosmetic surgery;
(k) radial keratotomy;
(l) private duty nursing;
(m) treatment for which other coverage such as workers' compensation is responsible;
(n) routine foot care;
(o) any medical transportation;
(p) ambulance services;
(q) abortions which are not performed to save the life of the mother or to terminate a pregnancy which is the result of an act of rape or incest;
(r) in vitro fertilization, gamete or zygote intra fallopian transfer, artificial insemination, reversal of voluntary sterilization, transsexual surgery, or fertility enhancing treatment beyond diagnosis;
(s) acupressure;
(t) contraceptives, for the purpose of birth control;
(u) temporomandibular joint (TMJ) treatment;
(v) hypnosis;
(w) cochlear implants and associated components;
(x) durable medical equipment; and
(y) any treatment which is not medically necessary.