We will not impose a pre-existing condition limitation period for a newborn child, an adopted child, or a child placed with you for adoption within 31 days of birth, adoption, or placement, respectively. We will credit month for month any prior coverage toward the limitation periods if you or your enrolled dependents were insured under another individual or group health insurance contract in the past 63 days. Upon termination of your prior coverage, you should receive a Certificate of Coverage indicating length of enrollment. Please submit your Certificate of Coverage with your application to ensure accurate crediting of the limitation periods. Skilled Nursing Facility care is limited to 60 days per calendar year.
Dental care is limited to the treatment of an accidental injury to natural teeth or a fractured jaw.
Diagnosis must be made within six months and treatment within 12 months of the injury. Mental Health Services Outpatient treatment is limited to 20 visits per calendar year. Detoxification will be paid without limitation, but must be authorized by Regence HMO Oregon. Services provided by a member of the patient s immediate family. Services rendered by a nonparticipating provider without our preauthorization, unless related to a medical emergency.