Regence Life & Health Insurance Company - InterM Medical Insurance Exclusions for Oregon Individuals and Families

Regence Life & Health

EXCLUSIONS
Your policy does not cover:

Pre-existing conditions ( There is no coverage for pre-existing conditions under this policy. Pre-existing condition means an illness or injury for which a covered person received any medical diagnosis, advice, treatment, service, supply, or drug prescription during the 5-year period immediately preceding the effective date of your policy. A condition is also pre-existing if, during the 5- year period immediately preceding the effective date of your policy, symptoms existed which would cause a prudent person to seek diagnosis, advice, care, or treatment.)
Illness or injury incurred in the course of any employment for wage or profit or for which benefits are available under Workers’ Compensation or similar law.
Illness or injury covered by Medicare.
Hospital confinement for medical observation or diagnostic exams.
Eye refractions, routine physical exams, tests or screening procedures (except breast and pelvic exams, mammograms, and Pap smear exams), well baby care, immunizations, hearing aids, eyeglasses, or hearing tests.
Treatment of drug abuse or drug addiction.
Organ transplant or complications resulting from or related to an organ transplant, except as specifically provided in your policy.
Treatment of intentional self-inflicted injury.
Elective sterilization, family planning, birth control drugs or devices, artificial insemination, in vitro fertilization, diagnosis or treatment of infertility, reversal of sterilization, or genetic testing or counseling.
Cosmetic surgery (certain exceptions apply).
Services or supplies not reasonably intended for treatment of illness or injury or which are not medically necessary (as defined in your policy).
Acupuncture, massage, or massage therapy.
Private duty nursing for hospital or skilled nursing facility inpatients.
Mental, emotional or nervous disorders, or counseling of any type, or treatment of learning disorders or disabilities.
Any condition caused by or arising out of service in the armed forces of any country, or from war or any act of war, or from participation in a felony, riot, or insurrection.
Sexual dysfunction or inadequacy, or sex change procedures and any resulting complications.
Services provided by an immediate family member.
Treatment for obesity or weight control, including surgery and any resulting complications.
Charges incurred after your policy ends, except as stated in your policy (see section titled “Extension of Benefits While Hospitalized” for brief description).
Charges which exceed usual and customary or reasonable (as defined in your policy).
Services rendered by governmental agencies or facilities, except as provided by law.
Dental exams, treatment, or orthodontics.
Services or supplies to change the position of the bone of the upper or lower jaw (certain exceptions apply).
Services or supplies that are experimental or investigational (see your policy for complete details).
Confinement in a health facility for custodial or maintenance care, rest, or to change a patient’s environment.
Pregnancy or childbirth, except complications of pregnancy as stated in your policy.
Treatment of alcoholism, except as stated in your policy.
Charges which are reimbursed due to third party liability or motor vehicle coverage (see your policy for complete details).

This is not the insurance contract and only the actual policy provisions will govern. Please refer to the policy for a detailed description of the rights and obligations of both you and Regence Life and Health Insurance Company.