Description / Exclusions / Application (select Coverage Type: Short Term

NON-RENEWABLE PLAN
This is a non-renewable plan. Benefit accumulations are not continuous from one Quick Net plan to any following Quick Net Plan. However, you may reapply for a new Quick Net plan. Successive plan approval will include a review for the following:

• No claims have been incurred under the previous Quick Net plan.
• There is no significant change in your health.
• The total days of coverage for all Quick Net plans does not exceed 365 days.

SUMMARY OF EXCLUSIONS AND LIMITATIONS

To help you make an informed decision, we’ve listed some services that are either limited or excluded from coverage. This is not a complete list of all exclusions and limitations. Please refer to the policy documents for complete details. You’ll have up to 10 days from the receipt of the Quick Net monthly policy to decline the coverage contract.

• Pre-existing conditions and related services (Pre-existing condition means a condition for which medical advice, diagnosis, care or treatment was recommended or received during the six-month period preceding the effective date of coverage. Pregnancy is a pre-existing condition. Genetic information does not constitute a pre-existing condition in the absence of a diagnosis of the condition related to such information.
• non-medically necessary care;
• benefits available to you under other insurance;
• experimental or investigational services;
• non-emergency services for which prior authorization is required;
• complications related to excluded coverage;
• non-medically necessary private room or private/special nurses; cosmetic services;
• temporomandibular (jaw) joint disorders or uncovered dental services;
• custodial care, respite care; routine eye/vision exams and services;
• hearing exams; corrective appliances and artificial aids;
• reduction or augmentation mammoplasty;
• medical or psychological report preparation for third parties;
• military service connected disabilities;
• diagnosis and treatment of infertility;
• reversal of voluntary sterilization;
• services/supplies related to sex transformation, transsexualism or paraphilias (sexual deviations);
• diagnosis and treatment for obesity and eating disorders;
• all organ and tissue transplants or autologous stem cell rescue or any complications resulting from such procedure;
• organ donor services; personal comfort items;
• learning disorders, except as provided in the contract;
• speech generating devices;
• rehabilitation therapy, except as provided in the contract; treatment of impotency;
• genetic engineering;
• non-medical self-help training or therapy; bone bank and eye bank charges;
• noncovered prescription drugs;
• specific biofeedback and pain management treatments or programs;
• hair analysis, autologous extraction and storage of blood;
• routine foot care, including treatment for corns, calluses and cutting of nails unless prescribed for the treatment of diabetes;
• growth hormone therapy;
• family planning; preventative and routine examinations, services, testing, and supplies except as provided in the contract;
• non-medically necessary circumcisions;
• drug and chemical dependency detoxification;
• non-covered congenital defects or diseases;
• chiropractic, acupuncture, naturopathy, massage therapy, and hypnotherapy services;
• allergy services;
• health education services other than diabetes selfmanagement education;
• mental health benefits;
• services of a nutritionist, except as outlined for diabetes management and inborn errors of metabolism;
• services and supplies for which the Member is not required to pay or that the Member would receive at no cost in the absence of health coverage;
• services and supplies for which the member is not billed by a provider or for which we are billed a zero dollar charge;
• all services provided in wilderness residential treatment programs;
• services and supplies rendered by an immediate family member (spouse, domestic partner, parent, child, grandparent or sibling related by blood, marriage or adoption) or prescribed or ordered by an immediate family member of the Member;
• Member self-treatment, including but not limited to self-prescribed medications and medical selfordered services and laboratory tests.

WHEN DOES COVERAGE BEGIN?

• If you are approved, your coverage will begin on the effective date you choose, as long as it does not precede the postmark date of your application and is within 30 days of the signature date.
• If your chosen effective date precedes the postmark date on your application, your coverage will become effective the day after the postmark date.
• Applications submitted without payment or with partial payment will be pended until payment is received. If payment is not received within two weeks of the application signature date, the application will be withdrawn.
• If you apply for a regular term Health Net medical insurance plan or enroll in a Health Net group medical insurance plan after your Quick Net plan is in effect, your Quick Net plan must expire before your regular term medical insurance plan becomes effective.