Arizona Health Insurance > Assurant Health/Time Insurance Company > General Exclusions

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Exclusions Summary

No benefits are provided for the following, except where state mandates apply:

• Charges incurred due to a pre-existing condition until you have been continuously insured for 12 months unless the condition was fully disclosed on the application
• Illness or injury caused by war, commission of a felony, attempted suicide, influence of an illegal substance, 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, unless you choose the dental insurance option
• Non-surgical treatment for TMJ or CMJ other than that described in the contract, or any related surgical treatment that is not preauthorized
• Any correction of malocclusion, protrusion, hypoplasia or hyperplasia of the jaws
• Charges for educational testing or training, vocational or work hardening programs, transitional living, or services provided through a school system
• Diagnosis and treatment of infertility
• Maternity and routine nursery charges unless you choose the maternity option
• 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
• Contraceptive drugs or devices
• Drugs not approved by the FDA
• Drugs obtained outside the United States
• The difference in cost between a generic and brand name drug when the generic is available
• Treatment of “quality of life” or “lifestyle” concerns, including, but not limited to: smoking cessation; obesity; hair loss; sexual function, dysfunction, inadequacy or desire; or cognitive enhancement
• Treatment used to improve memory or to slow the normal process of aging
• Testing related to the diagnosis of behavioral conduct or developmental problems
• Chelation therapy
• Prophylactic treatment
• Cranial orthotic devices, except following cranial surgery
• Telemedicine (including but not limited to treatment rendered through the use of interactive audio, video or other electronic media)
• Experimental or investigational services
• Charges in excess of the lifetime maximum or any other benefit maximum
• Charges for non-medical items
• Charges for alternative medicine including acupuncture and naturopathic medicine
• Charges related to health care practitioner assisted suicide
• Treatment of behavioral health (mental/nervous disorders) and substance abuse, including related prescription drugs
  
  

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