What is excluded?

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.

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This is limited benefit medical insurance that does not cover all medical costs.
 
Available in Alabama, Arizona, Arkansas, California, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Mississippi, New Mexico, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin and Wyoming.

Details of coverage may vary by state.


Preferred provider network (PPO) medical service providers are listed at Multiplan Limited Benefit Plan Network.

Contact the Core Health Insurance administrator's office directly for all verification, billing and claim questions at (800) 279-2290. If no answer, leave a detailed call-back message.

NEW! Core Dental Insurance is now available with medical insurance or as a stand-alone coverage. Either way, we think you will agree this is the best dental insurance available to individuals and families.

Have a question about eligibility or enrollment for any health insurance plan? E-mail OnlineNavigator for a fast response.

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@wealthmanagement.us.com.  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 uncompensated 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.