Regence BlueCross BlueShield of Oregon Health Insurance Plans for Oregon Plan Exclusions

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Oregon Medical Insurance > Regence BlueCross BlueShield of Oregon > Plan Exclusions

Medical Plan Limitations and Exclusions

A pre-existing condition is a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the six-month period before the effective date of coverage. The pre-existing condition period terminates six-months following the effective date of coverage.

Medical limitations and exclusions	Regence Evolve Core	Regence Evolve Plus	Regence Evolve HSA Plans
Alcoholism Treatment	$4,500 every two calendar years maximum (inpatient and outpatient combined)	$4,500 every two calendar years maximum (inpatient and outpatient combined)	$4,500 every two calendar years maximum (inpatient and outpatient combined)
Breast Reduction, Eye Lid Surgery, Varicose Vein Surgery	Excluded	$2,500 per lifetime maximum benefit	Excluded
Complementary Care (Acupuncture, chiropractic care and the services of an acupuncturist, a chiropractor and a naturopath)	Excluded	Limited to $500 per calendar year maximum benefit; not subject to deductible or coinsurance maximum. Does not include tobacco cessation services.	Excluded
Cosmetic/Reconstructive Services and Supplies	Excluded	Excluded	Excluded
Counseling in the Absence of Illness	Excluded	Excluded	Excluded
Custodial Care	Excluded	Excluded	Excluded
Drug Abuse Treatment	Excluded	Excluded	Excluded
Fees, Taxes, Interest	Excluded	Excluded	Excluded
Government Programs	Excluded	Excluded	Excluded
Hospitalization for Dentistry	Excluded	Excluded	Excluded
Infertility Treatment	Excluded	Excluded	Excluded
Investigational Services	Excluded	Excluded	Excluded
Medications without a Prescription Order	Excluded	Excluded	Excluded
Mental Health Treatment	Excluded	Inpatient: 6 days per calendar year Outpatient: 12 visits per calendar year	Inpatient: 6 days per calendar year Outpatient: 12 visits per calendar year
Military Service Related Conditions	Excluded	Excluded	Excluded
Motor Vehicle Coverage and Other Insurance Liability	Excluded	Excluded	Excluded
Non-Direct Patient Care	Excluded	Excluded	Excluded
Non-Duplication of Medicare	Excluded	Excluded	Excluded
Obesity or Weight Reduction/Control	Excluded	Excluded	Excluded
Orthognathic Surgery (except for congenital conditions, injury, and sleep apnea)	Excluded	Excluded	Excluded
Personal Comfort Items	Excluded	Excluded	Excluded
Physical Exercise Programs and Equipment	Excluded	Excluded	Excluded
Private Duty Nursing	Excluded	Excluded	Excluded
Riot, Rebellion and Illegal Acts	Excluded	Excluded	Excluded
Routine Foot Care	Excluded	Excluded	Excluded
Routine Hearing Exams	Excluded	Excluded	Excluded
Self-Help, Self-Care, Training or Instructional Programs	Excluded	Excluded	Excluded
Services and Supplies Provided by a Member of Your Family	Excluded	Excluded	Excluded
Services and Supplies That Are Not Medically Necessary	Excluded	Excluded	Excluded
Services to Alter Refractive Character of the Eye	Excluded	Excluded	Excluded
Sexual Reassignment Treatment and Surgery	Excluded	Excluded	Excluded
Sexual Dysfunction	Excluded	Excluded	Excluded
Temporomandibular Joint (TMJ) Disorder Treatment	Excluded	Excluded	Excluded
Third-Party Liability	Excluded	Excluded	Excluded
Tobacco Addiction Treatment	$500 per lifetime maximum benefit	$500 per lifetime maximum benefit	$500 per lifetime maximum benefit
Travel and Transportation Expenses (other than covered ambulance services)	Excluded	Excluded	Excluded
Routine Vision Exam and Hardware	Excluded	Combined $150 per calendar year maximum; not subject to deductible or coinsurance maximum	Excluded
Work-Related Conditions	Excluded	Excluded	Excluded
This chart does not contain all limitations and exclusions. Please refer to your policy for a complete list of benefits and the limitations and exclusions that apply

LifeWise Health Plans of Oregon

Regence BC BS of OR

ODS Health Plans

PacificSource

Providence Health Plans

HealthNet of Oregon

Kaiser Permanente

Oregon Medical Insurance Pool

Medicare Supplement Plans

Other Insurance

Oregon Medical Insurance > Regence BlueCross BlueShield of Oregon > Plan Exclusions

Medical Plan Limitations and Exclusions