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(Available to Washington State Residents Only) |

General Exclusions and Limitations
Benefit plans typically have exclusions and limitations — what the plans do not cover.
Listed here are general exclusions and limitations for LifeWise Health Plan of Washington benefit plans.
Please note that this is not a contract. The complete terms of coverage are determined by the contract.
What is not covered
Benefits are not provided for treatment, surgery, services, drugs or supplies for any of the following:
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Chemical dependency or tobacco addiction
Cosmetic or reconstructive surgery (except as specifically provided)
Dental services (except as specifically provided)
Experimental or investigative services
Hearing examinations or hardware
Infertility
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Learning disorders
Mental or psychiatric conditions
Neurodevelopmental disabilities
Obesity/morbid obesity
Orthognathic surgery
Orthotics, except for treatment of diabetes
Over-the-counter or non-prescription drugs
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Services in excess of specified benefit maximums
Services payable by other types of insurance coverage
Services received when you are not covered by this program
Sexual dysfunction
Sterilization reversal
Temporomandibular joint (TMJ) disorder
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Waiting periods
There is a 9-month waiting period for pre-existing conditions, unless otherwise specified. Treatment related to transplants
requires a 12-month waiting period.
Other exclusions and limitations to coverage
- Maternity/obstetrical care and prescriptions are not covered under WiseEssentials and WiseSavings plans.
- Vision Care is not covered under WiseEssentials and WiseSavings plans.
Please note that this is not a contract, nor is it a complete explanation of the exclusions
and limitations for LifeWise health plans.
The complete terms of coverage are determined by the contract.
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E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628, Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
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