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Plan Limitations |
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Short Term
Medical is designed to protect you in the event
of an unexpected illness or injury. Because of this, coverage
for preventive care, physicals, immunizations, dental or eye care are
not covered. |
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Following is a general summary of the
services not covered under this plan. |
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- Pre-existing conditions. (Any
sickness, injury, disease or physical condition for which medical treatment or advice was received from a physician within 5 years prior to
the effective date or which produced symptoms 5 years prior to the effective date of this
policy.)
- 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 United States, its
possessions or Canada.
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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. |
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