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Plan Exclusions

  • Routine physical examinations – first 12 months

  • Maternity and newborns – first 12 months

  • Mental and nervous – first 12 months

  • Dental treatment unless accident related

  • Organized amateur or professional sports

  • Treatment not ordered or received by a physician

  • Treatment or supplies not medically necessary

  • Investigational, experimental or research procedures

  • Custodial care

  • Weight modification

  • Elective cosmetic or plastic surgery

  • Treatment of impotency

  • Contraceptive medication or treatment

  • Drug and alcohol abuse treatment

  • Organ transplants not specifically listed

  • Devices to correct sight or hearing

  • Routine foot care

  • Treatment by a relative or family member

  • Treatment as a result of war or riot

  • Treatment resulting from illegal activities

  • Speech therapy

  • Persons HIV+ at effective date

  • Services and treatment eligible for payment by any government or other insurance

 

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US Calls: 1-877-982-5200 | International Calls: 1-781-982-5200 |

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