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What The Plan Does Not Cover
Every health plan has exclusions and limitations. These listings are
an overview only. A comprehensive description of what is covered and
what is not covered under the plan can be found in the Policy booklet.
- No payment will be made for services or supplies for the treatment
of a pre-existing condition during a period of six (6) months
following your effective date. However, if you were covered under
qualifying prior coverage within 63 days of becoming covered under
this Policy, the time spent under the qualifying prior coverage will
be used to satisfy, or partially satisfy the six month period.
- Services or supplies that are not medically necessary, as
determined by BC Life & Health.
- Experimental or investigative care or therapy.
- Services received before you Effective Date or during an inpatient
stay that began before your Effective Date.
- Services rendered before coverage begins or after coverage ends.
- Services or supplies for which no charge is made, of for which no
charge would be made if you had no insurance coverage of services
for which you are not legally obligated to pay.
- Conditions covered by workers' compensation or similar laws
- Conditions arising from any act of war, invasion, armed aggression
or release of nuclear energy.
- Any services provided by a local, state, county or federal
government agency including any foreign government.
- Any services to the extent that you are entitled to receive
Medicare benefits for those services, whether or not Medicare
benefits are actually paid.
- Services provided by relatives, and professional services received
from a person who lives in your home or who is related to you by
blood, marriage or adoption.
- Private duty nursing, including inpatient or outpatient service of
a private duty nurse.
- Custodial care.
- Services provided in a facility that provides continuous skilled
nursing care.
- Diagnostic admissions.
- Dental care and treatment or treatment on or to the teeth and gums
unless covered under accidental injury.
- Dental implants.
- Orthodontic services, braces and other orthodontic appliances.
- Hearing aids and routine hearting tests.
- Eyeglasses and eye examinations.
- Certain eye surgeries including those solely for the purpose of
correcting refractive defects of the eye such as nearsightedness
(myopia) and astigmatism.
- Cosmetic surgery. *Does not apply to reconstructive surgery to
restore a bodily function or to correct a deformity caused by injury
or medically necessary reconstructive surgery performed to restore
symmetry incident to mastectomy.
- Sex change operations or related treatment and study.
- Maternity care.
- WellBaby and WellChild Care.
- All services related to the evaluation of treatment of
infertility, including reversal of sterilization.
- Services primarily for weight reduction or treatment of obesity,
or any care which involves weight reduction as the main method of
treatment.
- Orthopedic shoes (except when joined to braces) or shoe inserts.
- Items which are furnished primarily for your personal comfort or
convenience.
- Consultations provided by telephone or facsimile machines.
- Nutritional counseling and food supplements except as stated in
your plan agreement.
- Educational services except as specifically provided or arranged
by BC Life & Health.
- Treatment furnished in a noncontracting California hospital except
for a medical emergency as defined in the Policy booklet.
- Routine physical exams
- Smoking cessation
- Durable Medical Equipment (DME)
- Outpatient Drugs and medications
- Outpatient speech therapy
- Treatment of sexual dysfunction
- Organ and tissue transplants
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