Preview
Plan Exclusions
Exclusions are an item or risk not covered by a plan. They are used to protect the plan from adverse selection. Plan benefits are excluded for items such as self-inflicted injury, war, drug and alcohol or accidents that occurred while committing a crime.
Below are important exclusions from the coverage:
- Workers’ Compensation Injuries
- Cosmetic Surgery Procedures
- Bariatric/Gastric Surgery
- Sex Transformation/Change Surgery
The Extended Inpatient and Outpatient Benefit provision has additional exclusions:
- The Extended Inpatient and Outpatient Benefit provision is effective 90 days after the effective date of the member;
- Maternity inpatient and outpatient services are effective 10 months after the effective date
- Any hospital confinement that began on or before the effective date is excluded from plan coverage
- Outpatient Drugs, Kidney Dialysis, Chemo Therapy, and All Other Infusion Therapy is excluded from coverage under Inpatient and Outpatient Provision
