Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 44 - SCOPE OF COVERAGE TO BE OFFERED BY THE NEBRASKA COMPREHENSIVE HEALTH INSURANCE POOL › Section 210-44-006 - Exceptions and limitations

Current through June 17, 2024
006.01 No benefits
				will be payable for:
006.01A Expense incurred
				while the policy is not in force.
006.01B Charges made by a physician for the
				treatment or movement of the teeth or tissues next to the teeth, except due to
				injury.
006.01C Injuries or
				sickness for which any benefits are provided for by workers' compensation or
				employer's liability laws whether or not you assert rights to such
				coverage.
006.01D Care of treatment
				in a hospital owned or operated by the United States Government or any of its
				agencies unless you are obligated to pay such charges.
006.01E Eye refractions, eyeglasses, contact
				lenses, hearing aids or their fitting.
006.01F Refractive corneal surgery, except
				for corneal grafts.
006.01G Private
				duty nursing.
006.01H Loss that
				results from an act of declared or undeclared war.
006.01I Loss sustained while in an armed
				service (Upon notice to the Pool of entry into a service, the pro rata premium
				will be refunded).
006.01J Normal
				childbirth, normal pregnancy, (unless insured purchases the optional Maternity
				Benefit Rider); or voluntarily induced abortion, or care of a newborn infant,
				except as provided by
				008.01K.
006.01K Complications of pregnancy when the
				pregnancy had its inception before the policy date. For a person eligible for
				CHIP benefits pursuant to Neb. Rev. Stat. §
										44-4221(1)(b)(i)
				 through §
										44-4221(1)(b)(iii),
				the policy will pay for complications of pregnancy regardless of whether the
				pregnancy began prior to the inception of eligibility for benefits under the
				CHIP policy.
006.01L Gender
				transformations or changes or the promotion of fertility including (but not
				limited to):
006.01L(1) Fertility
				tests.
006.01L(2) Reversal of
				surgical sterilization; and
006.01L(3) Direct attempts to cause pregnancy
				by hormone therapy, artificial insemination, in vitro fertilization or embryo
				transfer.
006.01M
				Routine physical exams or tests, except as provided in
				008.01I and
				008.01J.
006.01N Expenses incurred for the transplant
				of a part of the insured person's body to the body of another.
006.01O Treatment of a pre-existing condition
				or any complications of or resulting from such pre-existing condition, with the
				exception of prescription medication until the policy has been in force at
				least six months. This exclusion does not apply to an individual eligible for
				pool benefits pursuant to Neb. Rev. Stat. §
										44-4221(1)(b)(i)
				 through §
										44-4221(1)(b)(iii).
006.01P Expenses incurred for services or
				treatment not medically necessary, or not administered or not provided under
				supervision of a physician.
006.01Q
				Investigative or experimental services and supplies.
006.01R Any expenses incurred that are
				covered by any local, state or federal programs;
006.01S Loss that is covered by any other
				insurance plan.
006.01T Services or
				supplies for any person other than the insured.
006.01U Services performed by a member of the
				insured's immediate family.
006.01V
				Education or training of any type, including biofeedback, treatment of learning
				disabilities and attention deficit disorders, IQ testing unless expressly
				provided for in the policy.
006.01W
				Weight modification or for surgical treatment of obesity, including wiring of
				the teeth and all forms of intestinal bypass surgery, or breast reduction or
				augmentation.
006.01X Transplant
				surgery which is not precertified; and
006.01Y Custodial care.