Assurant Health - Online Application

Exclusions Summary

MEDICAL PLANS
No benefits are provided for the following:

• Charges incurred due to a pre-existing condition until you have been continuously insured for nine months.
• Sickness or injury caused by war, participation in a felony, attempted suicide, or a hazardous activity for which compensation is received.
• Routine hearing care, routine vision care, vision therapy, surgery to correct vision, routine foot care, or foot orthotics.
• Cosmetic services including chemical peels, plastic surgery, and medications.
• Charges by a health care practitioner or medical provider who is an immediate family member. Immediate family members are you, your spouse, your children, brothers, sisters, parents, their spouses, and anyone with whom legal guardianship has been established.
• Custodial care.
• Charges reimbursable by Medicare, Workers’ Compensation, or automobile insurance carriers.
• Growth hormone stimulation treatment to promote or delay growth.
• Routine dental care.
• Services provided through a school system.
• Diagnosis and treatment of infertility.
• Pregnancy, maternity, and other expenses related to surrogate pregnancy.
• Storage of umbilical cord stem cells or other blood components in the absence of sickness or injury.
• Genetic testing, counseling and services.
• Charges for sex transformation, treatment of sexual dysfunction or inadequacy, or to restore or enhance sexual performance or desire.
• Over-the-counter products.
• Outpatient prescription drugs.
• Treatment of “quality of life” or “lifestyle” concerns, including, but not limited to: smoking cessation, obesity, hair loss, or cognitive enhancement.
• Cranial orthotic devices, except following cranial surgery.
• Experimental or investigational services.
• Charges in excess of the lifetime maximum or any other benefit maximum.
• Charges for non-medical items.
• Charges related to health care practitioner assisted suicide.
• Treatment of substance abuse, including related prescription drugs.

OUTPATIENT PRESCRIPTION DRUG PLAN
No benefi ts are provided for the following:

• Charges for any amount in excess of any calendar year maximum benefit.
• Charges for any supplies, or drugs to treat, impact, or influence controlling the covered person’s weight; or charges related to obesity.
• Charges for supplies or drugs used for growth hormone therapy, including growth hormone medication and its derivatives or other drugs.
• Charges for supplies or drugs related to the following conditions, regardless of underlying causes: sex transformation; gender dysphoric disorder; gender reassignment; treatment of sexual function, dysfunction or inadequacy; treatment to enhance, restore, or improve sexual energy, performance, or desire.
• Charges for infertility diagnosis and treatment for males or females including, but not limited to, drugs and medications regardless of intended use.
• Charges for drugs that have not been fully approved by the FDA for marketing in the United States.
• Charges for any over-the-counter products or medications.
• Charges for prescription products, drugs, or medications in the following categories, whether or not prescribed by a health care practitioner:
  • Dietary or nutritional substances or dietary supplements
  • Nutraceuticals
  • Tube feeding formulas and infant formulas
  • Medical foods
    
• Charges for drugs dispensed at or by a health care practitioner’s office, clinic, hospital, or other non-pharmacy setting for take home by the covered person; amounts above the contracted rate for participating pharmacy reimbursement.
• Charges for any ancillary charge or any difference between the cost of the prescription order at a nonparticipating pharmacy and the contracted rate that would have been paid for the same prescription order had a participating pharmacy been used.
• Charges for any drug used for cosmetic services; drugs used to treat onychomycosis (nail fungus); botulinum toxin and its derivatives.
• Charges for drugs prescribed for dental services, or unit-dose drugs; drugs used in the treatment of chronic fatigue or related syndromes or conditions; drugs containing nicotine or its derivatives.
• Charges for DDAVP (desmopressin acetate) or other drugs used in the treatment of nocturnal enuresis (bedwetting) for a covered person under the age of 8.
• Charges for drugs used to treat, impact, or influence quality of life or lifestyle concerns including, but not limited to: smoking deterrence or cessation; athletic performance; body conditioning, strengthening, or energy; prevention or treatment of hair loss; prevention or treatment of excessive hair growth or abnormal hair patterns.
• Charges for drugs used to treat, impact, or influence: skin coloring or pigmentation; social phobias; slowing the normal processes of aging; memory improvement or cognitive enhancement; daytime drowsiness; overactive bladder; dry mouth; excessive salivation; or hyperhidrosis (excessive sweating).
• Charges for drugs used for inpatient or outpatient treatment of behavioral health or substance abuse.
• Drug charges incurred outside of the United States; charges for drugs obtained from pharmacy provider sources outside the United States, except for covered charges that are received for an emergency medical condition.
• Charges for Retin-A (tretinoin) and other drugs used in the treatment or prevention of acne, rosacea or related conditions for a covered person age 30 or older.