MMC Benefits Handbook
What Is Not Covered
Are there any Exclusions under this Plan?
State variations may apply to coverage options, exclusions and limitations.
Read the Outline of Coverage in the Information Kit carefully. It will reflect any applicable state variations.
For Employees who Reside in States Other than New York
Exclusions: Benefits are not paid for any expenses incurred for any room and board, care, treatment, services, equipment, or other items:
  • For which no charge is normally made in the absence of insurance;
  • Provided outside the United States of America, its territories and possessions; except as described in the International Coverage Benefit;
  • Provided by the insured's immediate family member, unless a benefit specifically states that a member of your immediate family can provide Covered Care. Genworth will not consider care to have been provided by a member of your immediate family when:
    • The insured's immediate family member is a regular employee of the organization that is providing the services; and
    • Such organization receives payment for the services; and
    • The insured's immediate family member receives no compensation other than the normal compensation for employees in her or his job category;
  • Provided by or in a Veteran's Administration or Federal government facility, unless a valid charge is made to you or your estate;
  • Resulting from war or an act of war, whether declared or not, provided that:
    • The impairment results from illness or injury that occurs while the insured person is serving in the military, naval or air forces of any country, combination of countries or international organization; and results from the special hazards incident to service in the military, naval or air forces of any country, combination of countries or international organization, if the impairment results form illness or injury that occurs while the insured person is serving in such forces and is outside the home area; or
    • The impairment results from war or an act of war while the insured person is serving in any civilian non-combatant unit supporting or accompanying any military, naval or air forces of any country, combination of countries or international organization; and results from the special hazards incident to service in any civilian non-combatant unit supporting or accompanying such forces, provided the illness or injury occurs while the insured person is serving in such unit and is outside the home area; or
    • The impairment results from illness or injury suffered as a result of war or an act of war while the insured person is not in the military, naval or air forces of any country, combination of countries or international organization or in any civilian non-combatant unit supporting or accompanying such forces, if the illness or injury occurs outside the home area.
  • Resulting from attempted suicide or an intentionally self-inflicted injury;
  • Resulting from participation in a felony, riot, or insurrection;
  • Resulting from the insured person's alcoholism or addiction to drugs or narcotics (except for an addiction to a prescription medication when administered in accordance with the advice of a physician);
  • For which the insured person receives, or is eligible to receive workers' compensation benefits, occupational disease act benefits, or similar benefits.
  • Benefits will be paid only for Covered Care expenses that are in excess of the amount paid or payable under:
  • Medicare (including amounts that would be reimbursable but for the application of a deductible or coinsurance amount); and
  • Any other federal, state or other governmental health care program or law except Medicaid.
For Employees who Reside in New York
Exclusions: Benefits are not paid for any expenses incurred for any room and board, care, treatment, services, equipment, or other items:
  • For which no charge is normally made in the absence of insurance;
  • Provided outside the United States of America, its territories and possessions; except as described in the International Coverage Benefit;
  • Provided by the insured's immediate family, unless a benefit specifically states that a member of the immediate family can provide Covered Care. Genworth will not consider care to have been provided by a member of the immediate family when:
    • The insured's immediate family member is a regular employee of the organization that is providing the services; and
    • Such organization receives payment for the services; and
    • The insured's immediate family member receives no compensation other than the normal compensation for employees in her or his job category;
  • Provided by or in a Veteran's Administration or Federal government facility, unless a valid charge is made to the insured's estate;
  • Resulting from war or any act of war, whether declared or not;
  • Resulting from attempted suicide or an intentionally self-inflicted injury;
  • Resulting from participation in a felony, riot, or insurrection;
  • Resulting from the insured's alcoholism or addiction to drugs or narcotics (except for an addiction to a prescription medication when administered in accordance with the advice of a physician);
  • For which the insured person receives, or is eligible to receive, workers' compensation benefits, occupational disease act benefits, or similar benefits.
  • Benefits are payable for Alzheimer's disease, subject to the same exclusions, limitations and provisions otherwise applicable to other Covered Care.
Non-Duplication of benefits: Benefits will be paid only for Covered Care expenses that are in excess of the amount paid or payable under;
  • Medicare (including amounts that would be reimbursable but for the application of a deductible or coinsurance amount); and
  • Any other federal, state or other governmental health care program or law except Medicaid.
Alternate plan of service provision
What if the service I want is not covered?
Alternate care expenses not otherwise covered by the Plan, may be covered when the insured, his or her physician if appropriate and Genworth agree in writing to the alternate care services. Prior approval is required. Genworth must determine that the care or services are qualified Long Term Care services that are cost-effective and appropriate; are consistent with general standards of care; provide an equal or greater quality of care than other services covered by the Plan; and are clearly specified in the insured's Plan of Care and in a separate written mutual agreement between the insurer and the insured.