Exclusions and Limitations
HMOs may not exclude and limit benefits as readily as commercial
insurers
because the rationale of an HMO is to provide comprehensive health
care
coverage.
Some of the benefits an HMO may exclude from coverage, and often
do,
include
➤ Eye examinations and refractions for persons over age
17
➤ Eyeglasses or contact lenses resulting from an eye examination
➤ Dental services
➤ Prescription drugs (other than those administered in a
hospital)
➤ Long-term physical therapy (more than 90 days)
➤ Out-of-area services (other than emergency services)
