Plan Exclusions
The following general summary of the services
not covered under this plan may vary according to the state in which the insured
resides.
Pre-existing conditions.
- Free services of a federal, veteran's, state
or municipal hospital.
- Charges for the services of a standby
physician except in limited circumstances.
- Charges for treatment of the covered person's
intentionally self-inflicted illness or injury, whether sane or insane.
- Charges for treatment of an illness or injury
caused by or contributed by: (a) worker's compensation or occupational
disease laws; (b) the participation in the military service; (c) war or act
of war, (d) attempt to commit a felony.
- Charges for treatment of an illness or injury
that occurs while the covered person has been under the influence of illegal
narcotics or non-prescribed controlled substance.
- Charges for cosmetic treatment or
reconstructive or plastic surgery that is primarily a cosmetic procedure.
- Charges for hearing aids; eyeglasses; contact
lenses; eye exams; eye refraction; eye surgery for correction of refraction
error; corrective shoes; repairs to or replacement of prosthetic devices.
- Charges for normal pregnancy or childbirth,
genetic testing, counseling or therapy including but not limited to,
amniocentesis and chorionic villi testing; abortion, except as provided in
the Complications of Pregnancy Provision; infertility treatment; artificial
insemination; in-vitro fertilization; and sterilization or reversal of
sterilization.
- Charges for treatment, medications or hormones
to stimulate growth and any other treatment or surgery for weight control or
obesity.
- Charges for treatment of mental disorders,
mental illness or substance abuse.
- Charges for dental treatment unless a hospital
stay is required due to injury.
- Charges for services rendered by or supplies
purchased from a member of your immediate family.
- If the covered person is eligible for
Medicare, that part of any charge for which a benefit would be paid under
Medicare or any other government law or program (except Medicaid); or
Medical coverage under any automobile insurance.
- Charges for treatment, repair or removal of
the tonsils or adenoids, except on an emergency basis.
- Charges for living expenses; and travel or
transportation expenses.
- Charges for treatment of chronic pain
disorders; biofeedback; custodial care; self-help programs.
- Charges for experimental or investigational
treatment.
- The first $2500 or 50% (whichever is the
lesser amount) of otherwise covered charges not authorized in accordance
with the Authorization Provision or any expense for bone marrow, heart,
liver or kidney transplant if the procedure was not authorized prior to the
beginning of the donor search and selection.
- Charges incurred after coverage terminates.
- Charges incurred outside the U.S. Canada, or
U.S. possessions.
Although the above provides a good description
of the important features of the Short Term Medical plan, this is not the
insurance contract and only the actual contract defines coverage. Exclusions may
vary by state and by the terms of the insurance contract. The policy itself sets
forth in detail the rights and obligations of both you and the insurance
company.