• Exclusions

Questions about your plan? Call us.

General Limitations and Exclusions for Most Plans

We want to help you understand what is covered by your health plan and answer your questions. This list will give you a general idea of what isn't covered—what is excluded—but if you want to know about a specific service, it's best to call us or refer to your member materials. 

What Does Calendar Year Mean?

Unless otherwise noted on your materials, benefits are calculated on a calendar year basis—regardless of when you enrolled. Out-of-pocket maximums, limitations, and deductibles start over every year on January 1.

What Are Excess Charges?

Charges from doctors or facilities that exceed our allowed amount for covered services are called excess charges. You are responsible to pay for excess charges from nonparticipating providers and facilities. These charges do not apply to your out-of-pocket maximum.

Are Services Related to Noncovered Services Also Excluded?

If you get a noncovered service at the same time as a covered service (such as a covered operation), only charges relating to the covered service will be considered for payment. Charges related to the noncovered service may not be paid.

These Services are Not Covered

Unless otherwise noted in your Member Payment Summary, the following services are not covered:
  • Abortions, selected types of
  • Acupuncture and acupressure
  • Administrative services/charges, for nonmedical purposes
  • Allergy tests, treatment, and services, selected types of
  • Anesthesia, selected types of
  • Attention-Deficit and Hyperactivity Disorder (ADHD)
  • Bariatric surgery
  • Biofeedback and neurofeedback
  • Birthing centers and home childbirth
  • Cancer therapy, selected types of
  • Chiropractic services
  • Complementary and Alternative Medicine (CAM)
  • Certain complications from a noncovered service
  • Certain durable medical equipment
  • Certain behavioral health/chemical dependency services
  • Claims after one year
  • Custodial care
  • Debarred providers
  • Dental anesthesia
  • Duplication of coverage
  • Exercise equipment and fitness training
  • Experimental or investigational treatments and services
  • Eye surgery, refractive
  • Food supplements
  • Gene therapy
  • Habilitation therapy services (large employer plans only)
  • Hearing aids, selected types of
  • Home health aides
  • Illegal activities, selected types of
  • Immunizations, selected types of
  • Infertility treatment
  • Methadone therapy
  • Non covered service in conjunction with a covered service
  • Pain management services, selected types of
  • Pervasive developmental disorder
  • Prescription drugs, injectable drugs, and specialty medications, selected types of
  • Reconstructive, corrective, and cosmetic services, selected types of
  • Rehabilitation therapy services, selected types of
  • Related provider services
  • Respite care
  • Robot-assisted surgery
  • Services that are not medically necessary
  • Sex reassignment surgery
  • Sexual dysfunction
  • Telephone and e-mail consultations
  • Temporomandibular Joint (TMJ) disorder and orthognathic (Individual plans only)
  • Terrorism or nuclear release
  • Travel-related expenses
  • War, related services
Log in to My Health to view your claims and plan information.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 。


CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 번으로 전화해 주십시오.


ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । SelectHealth Advantage: 1-855-442-9900 (TTY: 711)/ SelectHealth: 1-800-538-5038 मा फोन गर्नुहोस्।


FAKATOKANGA’I: Kapau ‘oku ke lea fakatonga, ko e kau fakatonu lea te nau tokoni atu ta’etotongi, pea te ke lava ‘o ma’u ia. Telefoni ki he SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.

Hū‘anga ki tu‘a

ОБАВЕШТЕЊЕ: Ако говорите српски језик, услуге језичке помоћи доступне су вам бесплатно. Позовите Select Health Advantage: 1-855-442-9900 (TTY- Телефон за особе са отежаним говором или оштећеним слухом: 711)/Select Health: 1-800-538-5038.


PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل بشركة SelectHealth Advantage: 1-855-442-9900 (رقم هاتف الصم والبكم: 711) / SelectHealth: 1-800-538-5038.


ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги переводчика. Позвоните SelectHealth Advantage: 1-855-442-9900 (телетайп: 711) / SelectHealth: 1-800-538-5038.


សម្គាល់៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ សេវាជំនួយផ្នែកភាសា ដោយមិនគិតថ្លៃ គឺអាចមានសំរាប់ អ្នក។ សូមទូរស័ព្ទមក SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038 ។


注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. まで、お電話にてご連絡ください。


ATTENTION : si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Contactez SelectHealth Advantage au 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.