Exclusions and Limitations

General Exclusions & Limitations

Benefit plans typically have exclusions and limitations – what the plans do not cover. Listed here are general exclusions and limitations for LifeWise Health Plan of Washington benefit plans. Plans are only available to WA state residents under age 65 and exclude those eligible for Medicare. Eligible family members include unmarried children under age 25.

Please note that this is not a contract, nor is it a complete explanation of the exclusions & limitations for LifeWise Health Plan of Washington plans. The complete terms of coverage are determined by the contract. If you would like a sample contract, please contact Green Financial.

What is not covered?

Benefits are not provided for treatment, surgery, services, drugs or supplies for any of the following:

Chemical dependency or tobacco addiction
Cosmetic or reconstructive surgery (except as specifically provided)
Dental services (except as specifically provided)
Experimental or investigative services
Hearing examinations or hardware
Infertility
Learning disorders
Mental or psychiatric conditions
Neurodevelopmental disabilities
Obesity/morbid obesity
Orthognathic surgery
Orthotics, except for treatment of diabetes
Over-the-counter or non-prescription drugs.
Services in excess of specified benefit maximums
Services payable by other types of insurance coverage
Services received when you are not covered by this program
Sexual dysfunction
Sterilization reversal
Temporomandibular joint (TMJ) disorder

Other exclusions and limitations

Maternity/Obstetrical care and prescriptions are not covered under WiseSimplicity, WiseEssentials, WiseEssentials Copay and WiseSavings plans.
Routine Vision Care is not covered under WiseSimplicity, WiseEssentials, WiseEssentials Copay and WiseSavings plans.
Allergy testing and injections are not covered under the WiseSimplicity, WiseEssentials, and WiseEssentials Copay plans.
Disposable diabetic supplies are not covered under the WiseSimplicity, WiseEssentials, WiseEssentials Copay and WiseSavings plans.

Waiting periods

There is a 9-month waiting period for pre-existing conditions, unless otherwise specified. In certain circumstances LifeWise will waive or credit this waiting period based on current or prior coverage. Treatment related to transplants requires a 12-month waiting period.