Exclusions
The Plan will not provide coverage for the following:
- Auto Accident Expenses are Expenses for treatment of an injury which is the result of an automobile
accident will not be covered to the extent of minimum coverage required
by any applicable state "no fault" law for injuries suffered
by a Covered Person if the Covered Person is the owner of the vehicle
and is operating or riding in the vehicle, and the vehicle is not
covered by no- fault insurance as required by law.
- Charges resulting from suicide, attempted suicide or intentionally
self-inflicted injury while sane.
- Expenses in connection with eye examinations, eye glasses, contact
lenses, radial keratotomy and laser surgery and/or related services or
hearing aids.
- Charges for treatment of Temporomandibular Joint (TMJ) disease are not
eligible under this plan.
- Expenses in connection with cosmetic treatment or cosmetic surgery,
except as a result of: a) a Covered Injury that occurred while
Insured under this policy; b) congenital disease or anomaly of a Covered
Newborn Child; or (c) as specifically provided for in the policy.
- Injury sustained while (a) participating in any interscholastic,
intercollegiate (unless the additional premium is paid), or professional
sport, contest or competition, (b) traveling to or from such sport,
contest or competition or competition as a participant, or (c) while
participating in any practice or conditioning program for such sports,
contest or competition, except as specifically provided in the policy.
- Expenses incurred for birth control drugs, procedures, supplies or
devices, including oral contraceptives. Drugs and medications for
the treatment of impotence and/or sexual dysfunction.
- Expenses incurred in connection with infertility diagnosis or
treatment, including in-vitro fertilization, artificial insemination, and
any other form of assisted contraception. Expenses incurred in
connection with sterilization or sterilization reversal, or vasectomy or
vasectomy reversal. Expenses incurred for voluntary or elective
abortion, or therapeutic termination of pregnancy.
- Loss due to war or any act of war, whether declared or undeclared, or
services in the Armed Forces of any country. Loss which occurs
during, or as a result of committing or attempting to commit an assault,
felony or participation in a riot or insurrection, engaging in an illegal
occupation.
- Expenses covered under any occupational benefit plan, Worker's
Compensation Act or similar law.
- Treatment in any Veteran's Administration or Federal Hospital, except
if there is a legal obligation to pay.
- Charges which are not Medically Necessary or in excess of the Usual and
Customary charges.
- Expenses incurred for dental care of treatment of the teeth, gums or
structures directly supporting the teeth, including surgical extractions
of teeth. This exclusion does not apply to the repair of injuries to
sound natural teeth caused by a covered injury, as outlined in the
Schedule of Benefits.
- Charges for acupuncture.
- Routine or Preventive services, unless otherwise noted in the brochure.
Insurance Company (carrier) Information
