Limitations & exclusions 

Our plans cover most of your health needs, but there are a few things that are not covered or have a set limit. These are called limitations and exclusions.




Limited covered services

Certain covered services have a coverage maximum for the calendar year. Limitations are set at a day and/or visit amount. Once the plan maximum is met, you will be responsible for costs until a new limitation period begins. The services below are subject to limitations and maximum coverage amounts.

Covered Service Oregon Plan Maximum  Washington Plan Maximum 
Inpatient Rehabilitation 30 days per calendar year, 60 days per calendar year for head/spinal injuries*

*Limits do not apply to Mental Health and Substance Use Disorder Services 		30 days per calendar year*

*Limits do not apply to Mental Health and Substance Use Disorder Services
Inpatient Habilitation 30 days per calendar year, 60 days per calendar year for head/spinal injuries*

*Limits do not apply to Mental Health and Substance Use Disorder Services		 30 days per calendar year*

*Limits do not apply to Mental Health and Substance Use Disorder Services
Outpatient Rehabilitation Services Outpatient rehabilitative services–physical, occupational or speech therapy

30 visits per calendar year*

*Limits do not apply to Mental Health and Substance Use Disorder Services 		Outpatient rehabilitative services–physical, occupational or speech therapy

30 visits per calendar year*

*Limits do not apply to Mental Health and Substance Use Disorder Services
Outpatient Habilitation Outpatient rehabilitative services–physical, occupational or speech therapy*

30 visits per calendar year

*Limits do not apply to Mental Health and Substance Use Disorder Services		 Outpatient rehabilitative services–physical, occupational or speech therapy*

30 visits per calendar year

*Limits do not apply to Mental Health and Substance Use Disorder Services
Skilled Nursing Facility Care 60 days per calendar year  60 days per calendar year
Removable Custom Shoe Orthotics $200 per calendar year*

*Limits do not apply to Providence Standard and Providence Oregon Direct plans.		 $200 per calendar year
Biofeedback for Specified Diagnosis 10 visits per lifetime 10 visits per lifetime 

Exclusions

Our Individual and Family plans have exclusions–or what our plans do not cover. View a complete list of exclusions that apply to all of our plans, as described in our plan contract. Upon enrollment, you will be given a full plan contract with a complete description of your coverage.

In addition to those services listed as not covered in section 4 (also copied below), the following are specifically excluded from coverage under this Contract.

If you have questions about any of these limitations and exclusions, call our Individual and Family plans Sales team at 503-574-5000 or 800-988-0088.



Oregon residents

Some services and supplies are not covered by our plans, and most of these exclusions are listed below in an excerpt from the Providence Standard Signature Network contract. The section numbers correspond to that contract. The full list of exclusions for each plan can be found in the 2024 plan contract.



Washington residents

Some services and supplies are not covered by our plans, and most of these exclusions are listed below in an excerpt from the Providence Columbia contract. The section numbers correspond to that contract. The full list of exclusions for each plan can be found in the 2024 plan contract.

Select the type of exclusion you would like more information about:

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