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Exclusions and Limitations
The Individual & Family
plans for Group Health have general exclusions and
limitations as shown below. Any treatment or service for these
conditions becomes your responsibility and you will be required to pay
in full. Unless otherwise noted in Group Health's Medical
Coverage Agreements, these plans have a nine-month waiting period
for pre-existing conditions. If you've had prior coverage and Group
Health receives your application for coverage within 63 days of that
coverage, you may be eligible for portability on pre-existing
conditions once Group Health reviews your Certificate of Creditable
Coverage.
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Chemical
dependency (limited)
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Cosmetic
services (limited)
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Dental
services
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Experimental/investigational services
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Eyeglasses/contact lenses (not covered in HealthPays HSA plan only)
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Hearing
aids and related examinations
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Infertility
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Learning
disorders
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Maternity (excluded in all plans except Balance 1000, Balance 1500
and Welcome 500)
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Obesity/morbid obesity
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Orthognathic surgery (surgery to correct abnormal position of the
jaws)
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Orthotics (making and fitting of orthopaedic appliances), except for
treatment for diabetics
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Over-the-counter/non-prescription drugs
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Prescriptions (excluded in all plans except Balance 1000, Balance
1500 and
Welcome 500)
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Routine
foot care (limited)
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Services
or supplies not specifically listed as covered in the Medical
Coverage Agreement
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Services
received when you are not covered by this program
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Sexual
dysfunction
-
Sterilization reversal
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Temporomandibular joint (TMJ) disorder (limited)
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You may seek treatment for any of the conditions listed as excluded or
limited in the Medical Coverage Agreement (your contract with Group
Health). However, you will be responsible for the cost of
services not covered by this contract. This information is not a
contract, nor does it cover all exclusions or limitations. Once
you become a member you will receive a copy of your Medical Coverage
Agreement, which will outline your coverage in detail. If you would
like to see a sample copy of the Medical Coverage Agreement prior to
applying for this coverage, please let us know. |
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