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LifeWise Health Plan of Oregon
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Index | Exclusions
& Limitations | Locate
Providers | Brochure & Application
Plan Benefits:
WiseEssentials Benefits | WiseChoices Benefits | WiseSavings Benefits
Plan Rates:
WiseEssentials | WiseChoices | WiseSavings
General Exclusions & Limitations
Benefit plans typically have exclusions and limitations—what
the plans do not cover. The following are general exclusions
and limitations for the LifeWise benefit plans:
What is not covered
Benefits are not provided for services,
treatment, surgery, drugs or supplies
for any of the following:
- Alcohol dependency treatment
services (unless optional alcohol
endorsement is purchased)
- Biofeedback
- Chemical (drug addition) dependency
- Conditions arising from acts of
war or service in the military
- Cosmetic or reconstructive
services, except as specifically
provided in the contract
- Dental services (except as allowed
under the accident benefit included
in the WiseChoices plan)
- Experimental or investigative services
- Hearing exams and aids
- Infertility
- Mental health
- Obesity/morbid obesity
- Orthognathic surgery (unless it
meets medical criteria and as
required by ORS 743.706)
- Over-the-counter or
non-prescription drugs
- Services determined by us to
be medically unnecessary
- 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
- Treatment for work-related
conditions for which benefits
are provided by Workers’
Compensation or similar coverage
- Treatment of temporomandibular
joint (TMJ) disorder
Waiting periods
There is a 6-month waiting period
for pre-existing conditions.
A pre-existing condition is a medical
condition that was diagnosed, or for
which care, treatment, or advice was
received or recommended in the 6
months prior to your effective
date on your LifeWise plan.
Charges over the maximum
allowable amount
You may be responsible for charges
that exceed the maximum allowable
amount for covered services from
non-preferred providers.
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