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LifeWise HealthPlans of Washington: Exclusions & Limitations

Benefit plans typically have exclusions and limitations— what the plans do not cover.  The following are general exclusions and limitations for the benefit plans described in this Overview of Coverage.  

Please note that this is not a contract. The complete terms of coverage are determined by the contract.

Benefit plans typically have exclusions and limitations— what the plans do not cover. The following are general exclusions and limitations for the following LifeWise Health Plan of Washington benefit plans:

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
• Neurodopmental disabilities
• Obesity/morbid obesity
• 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 reversal
• Temporomandibular joint (TMJ) disorder

Waiting Periods
There is a 9-month waiting period for pre-existing conditions, unless otherwise specified. Treatment related to transplants requires a 12-month waiting period.

• Maternity/obstetrical care and prescriptions are not covered under WiseEssentials and WiseSavings plans.
• Routine Vision Care is not covered under WiseEssentials and WiseSavings plans.
• Allergy testing and injections are not covered under the WiseEssentials plan.
• Disposable diabetic supplies are not covered under the WiseEssentials and WiseSavings plans.