Oregon Medical Insurance > Oregon Medical Insurance Pool ( OMIP) / Federal Medical Insurance Pool (FMIP) > Plan Exclusions
FMIP Benefit Limitations And Exclusions
OMIP Benefit Limitations And Exclusions
FMIP contracts place some exclusions and limitations on the benefits available for the treatment of certain conditions and the use of certain procedures. These
exclusions and limitations are explained in the FMIP contract under Benefit Exclusions and Benefit Limitations.
Under no circumstances will FMIP pay more than $2 million in lifetime benefits for any enrollee. This amount applies to all contracts and is reduced by benefits paid under any prior FMIP contract.
Following is a BRIEF list of contract exclusions:
Abortion (except as defined in the FMIP Contract)
Acupuncture
Appliances or equipment primarily for comfort or convenience
Charges in excess of
reasonable amounts for services and supplies
Chiropractic care
Cosmetic or reconstructive surgery
Custodial care
Dental examinations and
treatment
Experimental or investigational procedures
Family planning services and supplies
Hearing aids (except as defined in the FMIP Contract), eyeglasses,
and contacts
Massage or massage therapy
Naturopathic medicine and treatment
Off the shelf orthopedic shoes and orthopedic inserts
Orthognathic
surgery (except as defined in the FMIP Contract)
Transplant ($250,000 max. per transplant)
Treatment for obesity or weight control (except as defined in the FMIP Contract)
OMIP contracts place some exclusions and limitations on the benefits available for the treatment of certain conditions and the use of certain procedures. These
exclusions and limitations are explained in the OMIP contract under Benefit Exclusions and Benefit Limitations.
Under no circumstances will OMIP pay more than $2 million in lifetime benefits for any enrollee. This amount applies to all contracts and is reduced by benefits paid under any prior OMIP contract.
Following is a BRIEF list of contract exclusions:
Acupuncture
Appliances or equipment primarily for comfort or convenience
Charges in excess of reasonable
amounts for services and supplies
Chiropractic care
Cosmetic or reconstructive surgery
Custodial care
Dental examinations and treatment
Experimental
or investigational procedures
Family planning services and supplies
Hearing aids (except as defined in the OMIP Contract), eyeglasses, and contacts
Massage
or massage therapy
Naturopathic medicine and treatment
Off the shelf orthopedic shoes and orthopedic inserts
Orthognathic surgery (except as defined in
the OMIP Contract)
Treatment for obesity or weight control (except as defined in the FMIP Contract)