Limitations and exclusions

Benefit plans typically have exclusions, what the plans do not cover, and limitations. Some benefit limitations and exclusions apply to all of our plans. The following is an overview of the most common exclusions and limitations that apply to our plans. Upon enrollment, you will be given a plan contract with a complete description of your coverage.

Limited covered services

Certain covered services have a coverage maximum for the calendar year. Limitations are set at a day/visit amount. Once the plan maximum is met, you will be responsible for costs until a new limitation period begins. The services below are subject to limitations and maximum coverage amounts.

Covered Service Plan Maximum
Inpatient Rehabilitation 30 days per calendar year, 60 days per calendar year for head/spinal injuries
Inpatient Habilitation 30 days per calendar year, 60 days per calendar year for head/spinal injuries
Outpatient Rehabilitation 30 visits per calendar year. Up to 30 additional visits per specified condition
Outpatient Habilitation 30 visits per calendar year. Up to 30 additional visits per specified condition
Skilled Nursing Facility Care 60 days per calendar year
Removable Custom Shoe Orthotics $200 per calendar year
Biofeedback for specified diagnosis 10 visits per lifetime

Exclusions

Our individual and family plans have exclusions – or what our plans do not cover. View a complete list of exclusions that apply to all of our plans, as described in our plan contract. Upon enrollment, you will be given a full plan contract with a complete description of your coverage.

If you have questions about any of these limitations and exclusions, call our individual and family plans sales team at 503-574-5000 or 800-988-0088.