Every health plan has limits, and knowing yours ahead of time helps you plan care with confidence. Here's what to know about OS BENEFiTS plan limitations — and where to check the details for your specific plan.
Services not covered on the PPO plans
The Core, Premium, and Max plans do not cover chemotherapy, radiation therapy, or dialysis. If you or a covered family member may need these treatments, please reach out to us — we'll help you understand your situation and talk through your options, which may include coverage available through the health insurance marketplace during open enrollment or after a qualifying life event.
Annual limits on covered services
Many benefits have per-year limits, which vary by plan. A few examples of how these work:
Hospital benefits are limited per year — for example, a set number of inpatient days, surgeries, and emergency room visits
Therapies and services like physical/speech/occupational therapy, chiropractic care, and home health care have per-year visit limits
Advanced imaging (MRI, CT, PET) has a per-year limit
Your exact limits are listed on your plan overview and in your Summary of Benefits and Coverage (SBC) — the numbers differ between Core, Premium, and Max, so check yours before scheduling ongoing care.
The VitalCare plans
VitalCare and VitalCare+ are built around virtual and everyday care — they don't include traditional hospitalization or maternity coverage. VitalCare+ includes Hospital Indemnity benefits, which pay cash directly to you if you're hospitalized (see our Hospital Indemnity article for details).
Planning care around your limits
If you're expecting a procedure, ongoing therapy, or a hospital stay, we'd genuinely rather hear from you before the care happens than after — we can confirm what's covered, what your limits are, and what it will cost you, so there are no surprises.
Questions about what your plan covers?
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