Exclusions and Limitations
As with all health plans, there are some exclusions. Your contract does not provide benefits for: Pre-existing
conditions (any illness, injury or other condition for which medical advice, diagnosis, care or treatment was recommended or received from a physician or other health care provider prior to the effective date of coverage or which existed prior to 12 months from the effective date of coverage) until
your coverage has been in force for 12 consecutive months; injury or disease recognized as compensable under Workers’ Compensation; outpatient services for mental health care and substance abuse treatment; maternity benefits for the first 12 months of coverage, regardless of when the pregnancy
occurs; services and supplies not medically necessary or not consistent with the diagnosis; treatment for which payment is made by any local, state or federal government (except Medicaid); services paid under Medicare or the Veterans Administration; any injury or disease related to war, declared or undeclared, or the military service; convalescent or custodial care; hair transplants; eyeglasses/contact lenses/ radial keratotomy and the examinations associated with them; hearing aids; experimental services; weight reduction or treatment for obesity; dental care and treatment and oral surgery (except for extraction of impacted teeth); physical therapy/occupational therapy, chiropractic care or speech therapy if such services are necessitated by
developmental delay.
A full disclosure of all benefits, exclusions and limitations is included in the Contract for this coverage. |
