Subscribe to the RSS Feed

Subscribe to the RSS Feed


Avmed Individual Health Insurance Exclusions and Limitations

Avmed Florida Health Insurance Quote

These medical plans expressly excludes expenses for the following health care services. This is only a partial list of the Exclusions for health care services. No benefits are payable for expenses which:

  • Are received prior to your Effective Date or after the date your coverage terminates;
  • Are not within the service categories described in the “What Is Covered?” section, any Amendment, unless such Services are specifically required to be covered by applicable law;
  • Are provided by a Physician or other health care Provider related to you by blood or marriage;
  • Are which is not Medically Necessary as defined in the Contract and determined by AvMed;
  • Are rendered at no charge;
  • Are for Adult Wellness, including routine or preventive care unless provided for in the policy;
  • Are for Anesthesia Administration Services;
  • Are for Foot Care, including non-surgical treatment of foot-related ailments, shoe inserts designed to effect conformational changes in the foot or foot alignment;
  • Are for Materinty/obstetrical Care, including inpatient and outpatient materinity/obstetrical care, prenatal care, delivery, or routine newborn care (unless optional coverage is selected, if available);
  • Are for Assisted reproductive Therapy (Infertility); including any drug treatment or procedure that promotes conception.
  • Are for Contraceptive medications, including injections,  devices, or other health care services, when provided for contraception unless medically necessary;
  • Are for Behavioral Health Services;
  • Are incurred for Cosmetic Services or aesthetic reasons, such as weight modification or surgical treatment of obesity;
  • Are incurred for Eye Care, including eye surgery to correct nearsightedness, farsightedness, or astigmatism;
  • Are for Complementary or Alternative Medicine services, including Nutritional therapy;
  • Are for modification of the physical body, including breast reduction or augmentation, and genderreassignment surgery;
  • Are for Weight Control services, including gastric surgeries and other procedures for the treatment of obesity or morbid obesity, as well as any related evaluations or diagnostic tests;
  • Are in relation to, or incurred in conjunction with, investigational treatment.
  • Are for exercise programs, including gym memberships or exercise equipment of any kind;
  • Are for Dental expenses or oral surgery
  • Are in relation to Hearing Aides (external or implantable) and services related to the fitting or provision of hearing aids, including tinnitus maskers, batteries and cost of repair;
  • Are in relation to Transplant Services;
  • Are in relation to Skilled Nursing Facilities;
  • Are for rehabilitative Therapies;
  • Are for Autopsy or postmortem examination services;