Our Plans
- Starbridge Choices
- Fundamental Care
- Starbridge Select
- Administrator login
- Why Starbridge Select
- Member resources
- Broker center
- Employer center
- Discount Networks
- Starbridge
Site Resources
Starbridge Select>Why Starbridge Select>Limitations & Exclusions
Dependent eligibility
Your eligible dependents are your spouse and your unmarried dependent children under 19 years of age (if in TX, 25 years of age). The age limit is under 25 if the child is enrolled full-time in an accredited school or college. Your dependent information will be specified after you enroll and have received your summary plan description booklet.
Pre-existing Condition Limitation (Medical) 1.
Pre-existing conditions are not covered under the Starbridge Select medical plans. A pre-existing condition is any condition for which you have been medically diagnosed, treated by, sought advice from, or consulted with, a physician during the 6 months before becoming insured under this plan. This provision will not apply to any expenses incurred after the end of a continuous period of 6 months of coverage under the policy during which no expense is incurred, no diagnosis, treatment, or advice is received, and a physician has not been consulted; or 12 months of continuous coverage under the policy. The definition may vary from state to state.
The pre-existing condition limitation above does not apply to newborn or adopted children, or to any pregnancy.
Any pre-existing condition limitation can be reduced by the period of time you were previously insured for the condition, provided you were validly insured under a prior plan with creditable coverage immediately prior to being insured under this plan, and became insured under this plan within 63 days of termination of your prior plan.
When Coverage Ends
Your insurance will terminate on the earliest of:
1. The date ending the last period for which You made any required premium contribution;
2. The date You enter the armed forces* of any country;
3. The date You are no longer a member of a class eligible for insurance;
4. With respect to a coverage, the date on which that coverage is canceled;
5. The date the policy is terminated or
6. The date your Employer ceases to provide this plan.
The insurance of a covered Dependent will terminate on the earliest of:
1. The date Your insurance terminates;
2. The date he/she enters the armed forces* of any country; or
3. The date he/she ceases to be a Dependent.
Membership in the reserves is not deemed entry into the armed forces.*
Benefit Limitations 1.
Coverage is not provided for services, supplies or equipment for which a charge is not customarily made in the absence of insurance. No coverage is provided for loss caused by or resulting from:
1. Injury or Sickness arising out of or in the course of employment; or which is compensable under any Workers' Compensation or Occupational Disease Act or Law;
2. Declared or undeclared war; or act of war;
3. Expenses which are not ordered or under the written direction of a Physician;
4. Cosmetic surgery. This does not apply to:
a. Reconstructive surgery incidental to or following surgery resulting from trauma, infection, or other diseases of the involved part; or
b. Reconstructive surgery because of a congenital disease or anomaly of a covered Dependent newborn or adopted infant; or
c. Reconstructive surgery on a non-diseased breast to restore and achieve symmetry between two breasts following a mastectomy.
5. Hearing examinations or hearing aids;
6. Vision services and supplies related to eye refractions or eye examinations, eyeglasses or contact lenses or prescriptions or fitting of eyeglasses other than for a disease process, and radial keratotomy, keratomileusis or excimer laser photo refractive keratectomy or similar type procedures or services;
7. Charges made by a health care provider if such provider is a member of the Covered Person's Immediate Family or is living with the Covered Person;
8. Any period of Custodial Care confinement in a Hospital or Skilled Nursing Facility;
9. Charges for Home Health Care Services, unless provided in lieu of a Hospital confinement.
10. The Covered Person’s commission of a felony;
11. Charges in connection with manipulations of the musculoskeletal System, which includes manipulation of the muscles, joints, soft tissue, bone, spine, as well as traction and massage and applications of heat and cold;
12. The treatment of mental or nervous disorders, alcoholism, or any form of substance abuse, except as specifically provided;
13. Intentionally self-inflicted Injury or suicide attempt while sane or insane;
14. Dental care and treatment, except that required by Injury and rendered within 6 months of the Injury;
15. Treatment which is determined to be Experimental or Investigational.