The medical expenses not covered by the Critical Care Benefit Program include, but are not limited to, the costs for items and services listed below. Additional exclusions can be found here:
- Expenses that are reimbursed by the HRA Plan, the 88 Plan, the NFL Player Disability & Neurocognitive Benefit Plan, the Former Player Life Improvement Plan and the NFL Dedicated Hospital Network Program.
- Expenses that are payable through an unrelated entity, such as an employer, an insurance company, a government agency or a health reimbursement account (other than the HRA Plan).
- Expenses that are not related to the treatment or alleviation of a Covered Condition.
- Expenses for services provided by a relative.
- Expenses that are not medically necessary.
- Charges which you are not obligated to pay or for which you are not billed or for which you would not have been billed except that they were covered under this Program.
- Assistance in the activities of daily living, including, but not limited to, eating, bathing, dressing or other custodial services or self-care activities, homemaker services and services primarily for rest, domiciliary or convalescent care.
- Experimental, investigational and unproven services including services that are medical, surgical, diagnostic or psychiatric in nature.
- Services to treat substance use disorders.
- Cosmetic surgery and therapies. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-esteem.
- Dental treatment and dental implants for any condition.
- Consumable medical supplies other than ostomy supplies and urinary catheters.
- Additional charges for private hospital rooms and/or private duty nursing.
- Artificial aids including, but not limited to, corrective orthopedic shoes, arch supports, elastic stockings, garter belts, corsets, dentures and wigs.
- All non-injectable prescription drugs, unless physician administration or oversight is required; injectable prescription drugs to the extent they do not require physician supervision and are typically considered self-administered drugs; non-prescription drugs; and investigational and/or experimental drugs, except as provided in the Critical Care Benefit Program.
The Critical Care Benefit Program may establish minimum standards for providers, such as required certifications or licensing.
Benefits are payable for the duration of your Covered Condition. If Cigna or the Critical Care Benefit Program should determine that you no longer have a Covered Condition, your benefits will cease.