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 26.

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
Cosmetic or reconstructive surgery (except as specifically provided)
Experimental or investigative services
Hearing examinations or hardware
Infertility
Learning disorders
Neurodevelopmental disabilities
Obesity/morbid obesity, including surgery, drugs, foods and exercise programs.
Orthognathic surgery (except when repairing a dependent child's congenital abnormality)
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 (on WiseAdvantage and WiseEssentials Rx only) and sterilization reversal
Temporomandibular joint (TMJ) disorder

Other exclusions and limitations

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

Waiting periods

There is a 9-month waiting period for pre-existing conditions (not applicable to individuals under the age of 19). There is a 12-month waiting period for coverage of transplants for all eligible members. Waiting periods may be reduced or waived for prior health plan coverage.