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(Available to Washington State Residents Only)
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Regence BlueShield Evolve Core
General Medical Exclusions
Coverage is not provided for any of the following, including direct complications or consequences that arise from:
- Breast Reduction, Eye Lid Surgery and Varicose Vein Surgery.
- Chemical Dependency Treatment.
- Cosmetic/Reconstructive Services and Supplies
except for reconstruction for functional injury and disease, to treat a congenital anomaly, and for breast reconstruction following a medically necessary mastectomy to the extent required by law.
- Counseling
in the absence of ilness.
- Custodial Care:
Non-skilled care and helping with activities of daily living.
- Fees, Taxes, Interest:
Charges for shipping and handling, postage, interest or finance charges that a provider might bill.
- Government Programs:
Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or governmental program.
- Hospitalization for Dentistry.
- Infertility
except to the extent covered services are required to diagnose such condition.
- Investigational Services:
Treatment or procedures (health interventions) and services, supplies, and accommodations provided in connection with investigational treatments or procedures.
- Maternity Care:
Materit benefits, including complications of pregnancy.
- Medications without a Prescriptions Order.
- Military Service Conditions:
The treatment of any condition caused by or arising out of a member's active participation in a war or insurrection or conditions incurred in or aggravated during performance in the Uniformed Services.
- Motor Vehicle Coverage and Other Insurance Liability.
- Neurodevelopmental Therapy Services.
- Non-Direct Patient Care
including appointments scheduled and not kept, charges for preparing medical reports, itemized bills or claim forms, and visits or consultations that are not in person, including telephone consultations and email exchanges.
- Obesity or Weight Reduction/Control:
Medical treatment, medication, surgical treatment (including reversals) programs, or supplies that are intended to result in or relate to weight reduction, regardless of diagnosis.
- Orthognathic Surgery
except for congenital conditions, injury, and sleep apnea.
- Orthotics
except for diabetic orthotics.
- Personal Comfort Items:
Items that are primarily for comfort, convenience, cosmetics, environmental control, or education.
- Physical Exercise Programs and Equipment
including hot tubs or membership fees at spas, health clubs, or other facilities; even if the program, equipment, or membership is recommended by the member's provider.
- Private Duty Nursing
including ongoing shift care in the home.
- Riot, Rebellion and Illegal Acts:
Services and supplies for treatment of an illness, injury, or condition caused by a member's voluntary participation in a riot, armed invasion, or aggression, insurrection, or rebellion or sustained by a member while committing an illegal act or felony.
- Routine Foot Care
including treatment of corns and calluses and trimming of nails.- Routing Hearing Care:
Routine hearing examinations, programs, or treatment for hearing loss including hearing aids (externally worn or surgically implanted) and the surgery and services necessary to implant them, except for cochlear implants.
- Self-Help, Self-Care, Training, or Instructional Programs
including childbirth classes, diet and weight monitoring services and instructional programs, including those to learn how to stop smoking and programs that teach a person how to use durable medical equipment or how to care for a family member.
- Services and Supplies Provided by a Member of Your Family.
- Services and Supplies That Are Not Medically Necessary.
- Services to Alter Refractive Character of the Eye.
- Sexual Reassignment Treament and Surgery:
Treatment, surgery and counseling services for sexual reassignment.
- Sexual Dysfunction:
Regardless of cause, except for counseling provided by covered, licensed mental health practitioners.
- Temporomandibular Joint Disorders (TMJ) Treatment.
- Third-Party Liability:
Services and supplies for treatment of illness or injury for which a third party is or may be responsible.
- Tobacco Addiction Treatment
including supportive items for addiction to tobacco, tobacco products, or nicotine substitutes, including prescription medications.
- Travel and Transportaion Expenses
other than covered ambulance services.
- Routine Vision Exam and Hardware.
- Work-Related Conditions
except for subscribers and spouses who are owners, partners or corporate officers and are exempt from state or federal workers' compensation law.
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E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
Copyright© 1998-2010, Maddock & Associates | Privacy Statement
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