Medical plans limitations and exclusions

DEPENDENT ELIGIBILITY

Dependents are a lawful spouse or registered domestic partner and eligible children up to age 26.

COVERAGE FOR CHILDREN RESIDING OUTSIDE THE SERVICE AREA

If your enrolled child(ren) resides outside the service area, we will extend benefits as if care were rendered by a participating provider. Out-of-area children may receive the in-network benefit level by using the Travel Network. If a Travel Network provider is not available, the services will be paid at the in-network benefit level if provided within a 30-mile radius of the child's residence or at the closest appropriate facility. Fees charged by out-of-area providers will be reimbursed at the maximum plan allowance for those services.

LIMITATIONS

EXCLUSION PERIODS

12-month exclusion period applies to:

Note: Your plan's exclusion period will be shortened one day for each day you had "creditable coverage" under another health plan, provided you do not have a 63-day lapse (or longer) in coverage immediately prior to your effective date in our plan.

EXCLUSION

For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your producer or write to Moda Health.

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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