The first 365 days of coverage for a condition if diagnosis, treatment or advice is received 90 days prior to the effective date.
The first three days of each admission that is not the result of an accidental injury, and those days beyond the 365th day of each admission.
Admissions to skilled nursing facilities or to any type of nursing home; any portion of a hospital admission that is primarily for skilled nursing care rather than acute care (such as skilled nursing days in a room that can be classed by the hospital as acute care or skilled nursing care, dependent upon need.)
Admissions for the primary purpose of performing acupuncture.
Admissions for dental care.
Services that are not medically necessary, except that court-ordered services are covered to the extent the service would otherwise be covered.
Any admissions for which you are not legally obligated to pay or which is covered for you under federal (other than Medicare or Medicaid), state or local laws.
Admissions for or related to a nervous or mental condition. This includes alcohol and substance abuse admissions.
