What Is Not Covered
As you read the following section, consider what has been said in "What is Covered" section. The description of what is covered provides the limits of the coverage as well as providing details of specific descriptions of the coverage. For example, it states that hospitalization is covered but only if that hospitalization provides medically necessary care, the care is not experimental or investigational care as those terms are defined in the Plan and the hospitalization and the proposed length of stay has been approved in accordance with the terms of the Plan. Also, in describing the scope of the coverage provided, the limits of that coverage are also described.
Accordingly, it is necessary to understand what care and treatment is covered before examining the specific care and treatment which is not covered by the Plan - the subject of this section. Also, the Plan provides no coverage for care or treatment for which the Member and/or the patient have no responsibility to pay.
