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What Are the Exclusions and Limitations?
The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:
- Charges not incurred during the Certificate period
- Services or treatment payable by another insurance or government
- Substance abuse
- Charges which exceed usual, reasonable and customary
- Investigational or experimental surgeries or treatment
- Custodial, educational or rehabilitative care
- Weight modification
- Cosmetic surgery, unless reconstructive surgery is directly related to a covered Injury or Illness
- Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
- Individuals HIV+ at effective date
- Drugs or treatment for sexual dysfunction
- Drugs or treatment to promote or prevent conception
- Devices or procedures to correct sight or hearing
- Self-inflicted Injury or Illness
- Foot care, unless related to a covered accidental Injury
- Treatment or supplies not ordered by a physician or not medically necessary
- Organ transplants, except for covered transplants
- Speech, acupuncture, occupational or sleep therapy
- Acts of terrorism, war, insurrection, riot or any variation thereof
- Dental treatment, except emergency treatment following a covered accident, or unless Dental Rider is purchased
- Orthodontia (Dental Rider Exclusion)
- Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)
Special Ilness Exclusion:
The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, tonsils, adenoids, disease of sebaceous glands, acne, other acne, sebaceous cyst, seborrhea, unspecified disease of the sebaceous glands, moles, skin tags, hypertrophic and atrophic conditions of the skin, nervous, hemorrhoids, the reproductive system, hernia, gallstones or kidney stones. If you are insured under the Risk Share Plan, all illnesses are excluded for the first 90 days of coverage.
This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.
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International Citizens
