KPS health plans

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Benefit Schedules:
Sound Harbor Elite | Essential Plus | Essential Five | HSA | HSA with RX
Rate Schedules:
Sound Harbor Elite | Essential Plus | Essential Five | HSA | HSA with RX

Coverage under these Individual Plans is limited to the diagnosis and therapeutic care or treatment of disease, sickness or injury, or the prevention of disease, sickness or injury as described in the contract.

Sound Harbor Classic Five & 50/50
Sound Harbor Esential Five
The Healthy Investor™-HSA Plans

The following services are specifically excluded from coverage:

1. Air conditioners, de-humidifiers, air purifiers.
2. Any care, treatment, or service received prior to your coverage effective date.
3. Any care, treatment, or service received after your coverage has ended.
4. Arch supports, shoe orthotics, corrective shoes, and elastic stockings, except as specifically provided for under the Diabetic Education, Equipment and Supplies benefit.
5. Artificial insemination, in vitro fertilization, and gamete intra-fallopian transplant (GIFT), including any direct or indirect complications or after-effects other than pregnancy. 
6. Biofeedback, except in the case of urinary incontinence.
7. Cardiac rehabilitation.
8. Charges for non-covered benefits and services, and resulting complications, including services not specifically described in the contract.
9. Conditions resulting from acts of war, whether declared or undeclared.
10. Cosmetic surgery, including treatment for complications of cosmetic surgery, except as provided for under the Plastic and Reconstructive Surgery benefit.
11. Developmental delay, speech delay, or other learning disabilities.
12. Enuresis training equipment.
13. Exercise equipment and whirlpool baths.
14. Experimental and Investigational procedures, as defined in the contract.
15. Hearing aids, hearing devices such as cochlear implants, and hearing exams.
16. Hospitalization solely for diagnostic purposes.
17. Inpatient rehabilitation.
18. Maintenance, custodial, or domiciliary care, except as provided for under the Home Health and Hospice Care benefit.
19. Medical services paid by the Veterans Administration or by state, local, or federal governmental programs.
20. Neurodevelopmental therapy.
21. Non-surgical treatment for deformities of the toes and feet, including routine foot care, except when such care is directly related to the treatment of diabetes.
22. Obesity treatment, including, but not limited to, provider office visits, surgical weight loss procedures, pre-surgical diagnostics and procedures, weight reduction programs (such as Weight Watchers), and dietary control programs.
23. Orthoptics (eye exercise programs), pleoptics, visual analysis therapy and/or training, and radial keratotomy.
24. Over-the-counter products (except insulin supplies for the treatment of diabetes), including, but not limited to, contraceptive devices or supplies, unless specifically listed as a benefit under the plan.
25. Personal comfort items (e.g., radios, telephones, televisions).
26. Private duty nursing.
27. Reversal of sterilization.
28. Self-help care of any form, including, but not limited to, non-medical self-care, self-help training, marital or sexual counseling.
29. Services, supplies, and drugs, which are not medically necessary for the treatment of an illness, injury, or physical disability, even though the services are not specifically listed as exclusions.
30. Services for any occupational illness or injury arising out of, or in the course of, an activity pertaining to any trade, business, employment (including self-employment), or occupation for wage or profit, whether or not a proper and timely claim was filed for such benefits under another plan or policy.
31. Services and supplies for, or associated with, care or work on the teeth; x-rays of the teeth and other dental procedures.
32. Services for the treatment of complications arising from a non-covered service or procedure, except for the complications of pregnancy.
33. Services for which there is no charge to you.
34. Services for which you are not legally required to pay.
35. Services provided by a person who is related to you by blood or marriage, or who resides in your home.
36. Sex change or other sexual transformation procedures.
37. Speech, occupational, educational, milieu, massage, and physical therapies, except as specifically included under the Home Health and Hospice Care benefit or the Rehabilitation benefit.
38. Treatment for abnormalities of the jaw, including malocclusion; jaw augmentation or reduction surgery (orthognathic surgery), except as provided for under the Oral Surgery benefit or the Plastic and Reconstructive Surgery benefit; diagnosis and treatment of temporomandibular joint (TMJ) disorders.
39. Treatment for sexual dysfunction including, but not limited to, sterility, infertility, impotence, or frigidity.
40. Treatment of chemical dependency disorders.
41. Treatment of sleep disorders, including studies, durable medical equipment such as C-pap machines, and surgeries.
42. Unnecessary duplicate diagnostic services for a single ongoing illness. Consultations for second surgical opinions are covered under the Professional Services benefit.
43. Services for elective care received in a foreign country.
44. Services and supplies not specifically described in the contract.

Additional Exclusions for the Sound Harbor
Essential Five and The Healthy Investor™- HSA plans:

1. Eyeglasses and contact lenses.
2. Pregnancy and maternity care, except for complications of pregnancy.
3. Prescription drugs and medications, except drugs dispensed at a hospital-based emergency room or as provided for under the Home Health and Hospice Care benefit. Does not apply to The Healthy Investor™-HSA Rx Option.
4. Sterilization.
   
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