Services Your Plan Doesn't Cover

How to determine what your plan doesn’t cover

Your Guide to Benefits lists services that HMSA covers and any limitations or exclusions of your health plan. Please review the “Services Not Covered” chapter in your plan’s Guide to Benefits to understand your plan as completely as possible. We highly encourage you to review your new Guide to Benefits every time you switch plans, as your new plan may have different benefits and limitations.

Why your plan doesn’t cover all medical services

Our benefits are designed to ensure the safety of our members, to promote appropriate utilization of services, and to keep health care costs in check.

Services that aren’t covered

Benefit exclusions are services that aren’t covered under your plan.

The “Services Not Covered” chapter in your medical Guide to Benefits describes benefit exclusions which include the following. Please see your Guide to Benefits for a comprehensive listing.

  • Certain counseling services (e.g., marriage and family counseling).
  • Services that are covered by a rider or add-on plan such as drug, vision, and dental services.
  • Services that are usually considered a member’s responsibility (such as over-the-counter medication).
  • Certain services that are part of infertility treatment.
  • Services that aren’t medically necessary or don’t meet HMSA’s payment determination criteria (for example, convenience treatments or investigational/experimental treatments).
  • Services your employer has chosen not to cover as part of their employer-sponsored health plan.
  • Cosmetic procedures that aren’t reconstructive or corrective and don’t meet HMSA’s medical policies for coverage.