Current through Register Vol. XLI, No. 38, September 20, 2024
5.1. Excluded
coverage by type. -- No Medicare Supplement or Limited Benefit Medicare Supplement
policy or contract shall limit or exclude coverage by type of illness, accident,
treatment or medical condition except as to the following, where not inconsistent
with Medicare:
(a) Foot care in connection with
corns, calluses, flat feet, fallen arches, weak feet, chronic strain or symptomatic
complaints of the feet;
(b) Mental or
emotional disorders, alcoholism and drug addiction;
(c) Illness, treatment or medical condition
arising out of:
(1) War or act of war (whether
declared or undeclared);
(2)
Participation in a felony, riot or insurrections;
(3) Service in the armed forces or units auxiliary
thereto;
(4) Suicide (sane or insane),
attempted suicide or intentionally self-inflicted injury;
(5) Aviation.
(d) Cosmetic surgery, except that "Cosmetic
Surgery" shall not include reconstructive surgery when such service is incidental to
or follows surgery resulting from trauma, infection or other diseases of the
involved part;
(e) Care in connection
with the detection and correction by manual or mechanical means of structural
imbalance, distortion or subluxation in the human body for purposes of removing
nerve interference and the effects thereof, where such interference is the result of
or related to distortion, misalignment or subluxation of or in the vertebral
column;
(f) Treatment provided in a
governmental hospital; benefits provided under Medicare or other governmental
program (except Medicaid), any state or federal workers' compensation, employer's
liability or occupational disease law or any motor vehicle no-fault law; services
rendered by employees of hospitals, laboratories or other institutions; services
performed by a member of the covered person's immediate family and services for
which no charge is normally made in the absence of insurance;
(g) Dental care or treatment;
(h) Eye glasses, hearing aids and examination for
the prescription or fitting thereof;
(i)
Rest cures, custodial care, transportation and routine physical
examination;
(j) Territorial
limitations:
Provided, That Medicare Supplement or Limited Benefit
Medicare Supplement policies or contracts may not contain limitations or exclusions
of the types included in Subdivisions (a), (e), (i) or (j) above that are more
restrictive than those of Medicare. Medicare Supplement or Limited Benefit Medicare
Supplement policies or contracts may exclude coverage for any expense to the extent
of any benefit available to the insured under Medicare.
5.2. Waivers. -- No Medicare Supplement or Limited
Benefit Medicare Supplement policy or contract may use waivers to exclude, limit or
reduce coverage or benefits for specifically named or described preexisting diseases
or physical conditions.
