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Blue Cross of California

Short Term PPO Plans for Individuals & Families

What The Plan Does Not Cover

Every health plan has exclusions and limitations. These listings are an overview only. A comprehensive description of what is covered and what is not covered under the plan can be found in the Policy booklet.

  • No payment will be made for services or supplies for the treatment of a pre-existing condition during a period of six (6) months following your effective date. However, if you were covered under qualifying prior coverage within 63 days of becoming covered under this Policy, the time spent under the qualifying prior coverage will be used to satisfy, or partially satisfy the six month period.
  • Services or supplies that are not medically necessary, as determined by BC Life & Health.
  • Experimental or investigative care or therapy.
  • Services received before you Effective Date or during an inpatient stay that began before your Effective Date.
  • Services rendered before coverage begins or after coverage ends.
  • Services or supplies for which no charge is made, of for which no charge would be made if you had no insurance coverage of services for which you are not legally obligated to pay.
  • Conditions covered by workers' compensation or similar laws
  • Conditions arising from any act of war, invasion, armed aggression or release of nuclear energy.
  • Any services provided by a local, state, county or federal government agency including any foreign government.
  • Any services to the extent that you are entitled to receive Medicare benefits for those services, whether or not Medicare benefits are actually paid.
  • Services provided by relatives, and professional services received from a person who lives in your home or who is related to you by blood, marriage or adoption.
  • Private duty nursing, including inpatient or outpatient service of a private duty nurse.
  • Custodial care.
  • Services provided in a facility that provides continuous skilled nursing care.
  • Diagnostic admissions.
  • Dental care and treatment or treatment on or to the teeth and gums unless covered under accidental injury.
  • Dental implants.
  • Orthodontic services, braces and other orthodontic appliances.
  • Hearing aids and routine hearting tests.
  • Eyeglasses and eye examinations.
  • Certain eye surgeries including those solely for the purpose of correcting refractive defects of the eye such as nearsightedness (myopia) and astigmatism.
  • Cosmetic surgery. *Does not apply to reconstructive surgery to restore a bodily function or to correct a deformity caused by injury or medically necessary reconstructive surgery performed to restore symmetry incident to mastectomy.
  • Sex change operations or related treatment and study.
  • Maternity care.
  • WellBaby and WellChild Care.
  • All services related to the evaluation of treatment of infertility, including reversal of sterilization.
  • Services primarily for weight reduction or treatment of obesity, or any care which involves weight reduction as the main method of treatment.
  • Orthopedic shoes (except when joined to braces) or shoe inserts.
  • Items which are furnished primarily for your personal comfort or convenience.
  • Consultations provided by telephone or facsimile machines.
  • Nutritional counseling and food supplements except as stated in your plan agreement.
  • Educational services except as specifically provided or arranged by BC Life & Health.
  • Treatment furnished in a noncontracting California hospital except for a medical emergency as defined in the Policy booklet.
  • Routine physical exams
  • Smoking cessation
  • Durable Medical Equipment (DME)
  • Outpatient Drugs and medications
  • Outpatient speech therapy
  • Treatment of sexual dysfunction
  • Organ and tissue transplants
Blue Cross of California
Blue Cross of California and BC Life & Health Insurance Company are independent licensees of the Blue Cross Association and are licensed to conduct business in the State of California

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Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389