Limitations and Exclusions
The health insurance plans indicated here do not cover all health care expenses and include exclusions and limitations. You should refer to plan
documents to determine which health care services are covered and to what extent.
Medical Limitations and Exclusions
Services and supplies that are generally notcovered include, but are not limited to:
- Surgery or related services for cosmeticpurposes to improve appearance, but not torestore bodily function or correct deformityresulting from disease, trauma or congenitalor developmental anomalies
- Private duty nursing
- Personal care services and home care servicesnot stated in the plan description
- Non-replacement fees for blood and blood products
Unless otherwise specified in covered services,dental work or treatment, including hospital or professional care in connection with:
- The operation or treatment for fitting orwearing of dentures
- Orthodontic care
- Dental implants
- Experimental services
- Immunizations related to foreign travel
- The purchase, examination, or fitting ofhearing aids and supplies, and tinnitusmaskers, unless included as a covered benefit.
- Arch support, orthotic devices, in-shoesupports, orthopedic shoes, elastic supports,or exams for their prescription or fitting,unless these services are determined to bemedically necessary.
- Inpatient admissions primarily for physicaltherapy unless authorized by the plan.
- Charges in connection with pregnancy care,other than for pregnancy complications
- Treatment of sexual dysfunction not related to organic disease
- Services to reverse a voluntary sterilization
- In vitro fertilization, ovum transplants andgamete intrafallopian tube transfer, orcryogenic or other preservation techniquesused in these or similar procedures
- Practitioner, hospital or clinical servicesrelated to the procedure commonly referredto as “Lasik Eye Surgery” including radialkeratomy, myopi keratomileusis, and surgerythat involved corneal tissue for the purpose of altering, modifying or correcting myopia,hyperopia or stigmatic error
- Nonmedical ancillary services such asvocational rehabilitation, employmentcounseling, or educational therapy
- Services that are not medically necessary
- Medical expenses for a pre-existing conditionare not covered for the first 12 months after themember’s effective date. Look-back period fordetermining a pre-existing condition(conditions for which diagnosis, care ortreatment was recommended or received) is 6months prior to the effective date of coverage. If the applicant had prior creditable coveragewithin 63 days immediately before the signatureon the application, then the pre-existingconditions exclusion of the plan will be waived.
- Weight control services including surgicalprocedures, medical treatments, weightcontrol/loss programs, dietary regiments andsupplements, appetite suppressants and othermedication; food or food supplements, exerciseprograms, exercise or other equipment; andother services and supplies that are primarilyintended to control weight or treat obesity,including Morbid Obesity, or for the purpose of weight reduction, regardless of the existenceof comorbid conditions.
30-day right to review
Do not cancel your current insurance until you are notified you have been accepted for coverage.We’ll review your application to determine if you meet underwriting requirements. If you aredenied, you will be notified by mail. If approved,you will be sent an AARP Essential Premier HealthInsurance contract and ID card. If, after reviewingthe contract, you find you are not satisfied for anyreason, simply return the contract to us within 30 days. We will refund any premium you havepaid less the cost of any services paid on behalf of you or any covered dependent.
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