Question for Health Insurance Experts

Plans have been known to exclude coverage for “risky” behavior………

EXAMPLE:

“Care or treatment for injuries/conditions directly related to a Member’s avocation/hobby that is considered to be one of high risk; including but not limited to sky-diving, operating on an all-terrain vehicle, para-sailing, bungeejumping, scuba-diving, operating small aircraft.”

Does refusing to take a vaccination constitute risky behavior?

Specifically can a plan sponsor exclude Covid treatment (particularly high cost hospitalization) if a member refuses to get a Covid vaccination?

We asked an ERISA attorney and he said………..

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