Core Health Insurance covers only the items included in the description of benefits and does not include coverage for any items not included in this list. For the most recent listing of benefits and exclusions that applies in your specific state, see the information on the description of benefits after you request an online quote. The following generic list of exclusions if provided for illustrative purposes.
Benefits will not be paid for charges or loss caused by, or
resulting from, any of the following:
(1) Suicide or any
intentionally self‑inflicted Injury;
(2) Any drug, narcotic,
gas or fumes, or chemical substance voluntarily taken,
administered, absorbed or inhaled unless prescribed by, and
taken according to the directions of, a Doctor (accidental
ingestion of a poisonous substance is not excluded.);
(3)
Commission, or attempt to commit, a felony;
(4)
Participation in a riot or insurrection;
(5) Driving under
the influence of a controlled substance, unless administered on
the advice of a Doctor;
(6) Driving while Intoxicated.
"Intoxicated" will have the meaning determined by the laws in
the jurisdiction of the geographical area where the loss occurs.
(7) Declared or undeclared war or act of war;
(8)
Nuclear reaction or the release of nuclear energy. However, this
exclusion will not apply if the loss is sustained within
180-days of the initial incident and:
(1) The loss was caused
by fire, heat, explosion or other physical trauma which was a
result of the release of nuclear energy; and
(2) The Covered
Person was within a 25-mile radius of the site of the release
either:
(a) At the time of the release; or
(b) Within
24-hours of the start of the release; or
(c) Occurs while he
is in the issue state of this Certificate;
(9) Routine health
checkups or immunizations for Covered Person aged 6 and older
except as specifically provided; allergy testing;
(10)
Surgery to correct vision or hearing; eyeglasses, contact lenses
and hearing aids, braces, appliances, or examinations or
prescriptions therefore;
(11) Dental care, x-rays, or
treatment other than Injury to natural teeth and gums resulting
from an accidental Injury and rendered within 6-months of the
Injury;
(12) Spinal manipulations and manual manipulative
treatment or therapy or physiotherapy;
(13) Weight loss or
modification and complications arising therefrom, including
surgery and any other form of treatment for the purpose of
weight loss or modification;
(14) Rest cures or custodial
care, or treatment of sleep disorders;
(15) Treatment,
services or supplies received outside of the U.S. except for
acute Sickness or Injury sustained during the first 30-days of
travel outside the U.S.;
(16) Normal pregnancy or
childbirth, except for Complications of Pregnancy;
(17) Any
drug, treatment, or procedure that either promotes or prevents
conception or childbirth regardless of what the drug, treatment,
or procedure was originally prescribed or intended for;
(18)
(19) Treatment of temporomandibular joint (TMJ) disorders
involving the installation of crowns, pontics, bridges or
abutments, or the installation, maintenance or removal of
orthodontic or occlusal appliances or equilibration therapy;
(20) Cosmetic surgery. This Exclusion does not apply to
reconstructive surgery:
(a) On an injured part of the body
following trauma, infection or other disease of the involved
part;
(b) Of a congenital disease or anomaly of a covered
dependent newborn or adopted infant; or
(c) On a non-diseased
breast to restore and achieve symmetry between two breasts
following a covered Mastectomy;
(21) The repair or
replacement of existing artificial limbs, orthopedic braces, or
orthotic devices; dentures, partial dentures, braces or fixed or
removable bridges;
(22) Treatment or removal of warts,
moles, boils, skin blemishes or birthmarks, bunions, acne,
corns, calluses, the cutting and trimming of toenails, care for
flat feet, fallen arches or chronic foot strain; ;
(23) (24)
Treatment of Mental or Nervous Disorders, or alcohol or
substance abuse, unless specifically provided for under this
Certificate;
(25) Prescription medicines;
(26 Any Injury
that is caused by flight or travel in, or upon:
(a) An
aircraft or other, craft designed for navigation above or beyond
the earth's atmosphere except as a fare‑paying passenger;
(b)
An ultra light, hang‑gliding, parachuting or bungi‑cord jumping;
(c)A snowmobile;
(d) Any two or three wheeled motor vehicle;
(e) Any off‑road motorized vehicle not requiring licensing as a
motor vehicle;
(f) Any watercraft or other craft designed for
water use above or beneath the water, except as a fare-paying
passenger;
(27) Any accidental Injury where the Covered
Person is the operator of a motor vehicle and does not possess a
current and valid motor vehicle operator's license;
(28)
Services, treatment or loss:
(a) Rendered in any Veterans
Administration or Federal Hospital, except if there is a legal
obligation to pay;
(b)Payable by any automobile insurance
policy without regard to fault. (Does not apply in any state
where prohibited);
(c) Which a Covered Person would not have
to pay if he did not have insurance;
(d) Provided by a
Doctor, Nurse or any other person who is employed or retained by
a Covered Person or who is a member of a Covered Person’s
Immediate Family;
(e) Covered by state or federal worker's
compensation, employers liability, occupational disease law, or
similar laws;
(f) Injury or Sickness sustained while on
active duty in the armed forces of any country. Upon receipt of
proof of service, we will refund, any unearned premium paid on a
pro rata basis;
(29) Hemorrhoids, tonsils, adenoids, middle
ear disorders, any disease or disorder of the reproductive
organs unless the loss is incurred at least 6-months after the
Covered Person becomes insured under this Certificate;
(30)
Elective treatment or surgery and treatment, procedures,
products or services that are experimental or investigative.
“Experimental or Investigative” means a drug, device or medical
treatment or procedure that:
(a) Cannot lawfully be marketed
without approval of the United States Food and Drug
Administration and approval for marketing has not been given at
the time of being furnished;
(b) Has Reliable Evidence
indicating it is the subject of ongoing clinical trials or is
under study to determine its maximum tolerated dose, toxicity,
safety, efficacy, or its efficacy as compared with the standard
means of treatments or diagnosis; or
(c) Has Reliable
Evidence indicating that the consensus of opinion among experts
is that further studies or clinical trials are necessary to
determine its maximum tolerated dose, toxicity, efficacy, or its
efficacy as compared with the standard means of treatment or
diagnosis. “Reliable Evidence” means (i) published reports and
articles in authoritative medical and scientific literature;
(ii) the written protocol(s) of the treating facility or the
protocols of another facility studying substantially the same
drug, device, medical treatment or procedure; or (iii) the
written informed consent used by the treating facility or by
another facility studying substantially the same drug, device,
or medical treatment or procedure.
OTHER NEW COVERAGE OPTIONS:: Obamacare supplement insurance, and high deductible insurance and a telemedicine plan also administered by SASID are available to help lower the high out-of-pocket expense of Affordable Care Act policies. Read more information, get rates and enroll online.
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CORE HEALTH INSURANCE IS A SUPPLEMENTAL INSURANCE AND IS NOT A REPLACEMENT FOR OBAMACARE. This insurance is not intended to help members or their employers comply with the provisions of the Affordable Care Act commonly known as the "individual mandate" and does not offer the provisions known as "minimum essential coverage" and will not satisfy the individual responsibility requirements of section 5000A of the Code. Questions about compliance with the Affordable Care Act may be directed to the free consumer assistance program at www.OnlineNavigator.org. Members of the Association of United Internet Consumers (AUIC) have access to this insurance, online discount programs including discount prescription drugs, and educational materials. As a member of AUIC, you are eligible for exclusive rates and plans. AUIC membership is available at time of insurance enrollment.
This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator" at P.O. Box 333, Newport NJ 08345.Telephone (800) 609-0683, Email tnovak@freedombenefits.net. DO NOT USE THIS TO COMMUNICATE WITH CORE HEALTH INSURANCE. Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed. "Core Health Insurance" is a brand owned by SASid, not related to the operator of this web site but marketed under a producer license agreement.