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Common Exclusions

This is a general list of exclusions.  Exclusions may vary by state.  Refer to your policy and riders for a full list of exclusions.

COMMON EXCLUSIONS

We will not pay Benefits under the Policy for any Injury that is caused by, or results from:

  1. suicide or attempted suicide or the Covered Persons intention; self-inflicted injury or sickness, while sane or insane;
  2. elective treatment and surgery;
  3. all Illnesses, disease, bodily or mental infirmity, bacterial or viral infection or medical or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound;
  4. any illness disease or condition including, maternity, routine nursery care, pregnancy, childbirth, miscarriage, mental and nervous disorders, abortion or any complication from these conditions;
  5. damage to or loss of dentures, bridges or demanding to exiting orthodontic work;
  6. any expense which are not expressly recommended by physician and or doctor or expenses that are not medical in nature;
  7. injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed Physician;
  8. commission of, or attempt to commit, a felony, an assault or other illegal activity or illegal occupation;
  9. a Covered Person’s commission of or active participation in a riot or insurrection;
  10. war or any act of war, whether declared or not; or service in the military, naval or air service of any country;
  11. piloting or serving as a crewmember or riding in any aircraft except as a fare-paying passenger on a regularly scheduled or charter airline;
  12. participation in or practice of engaging in hang gliding, bungee jumping, parachuting, sail gliding, para sailing, para kiting, motorize racing, or any similar activity undertaking for thrill seeking*;
  13. a Covered Person practicing for or participating in any intercollegiate or semiprofessional, professional competitive athletic contest where a Covered Person received any type of compensation or remuneration**;
  14. the Covered Persons riding in or driving any motor vehicles in a race, stunt show or speed test;
  15. injury sustained as a result of the Covered Person being legally intoxicated from the use of alcohol.  A Covered Persons conclusively determined to be legally intoxicated by alcohol if a test, including but not limited to a chemical or breath test, administered in the jurisdiction where the Injury occurred is at or above the legal limit set by that jurisdiction.

*Thrill seeking is defined as participating in an activity where failure of that activity results in death or catastrophic injury. Some examples of “thrill-seeking” activities includes: slack-lining, free-soloing, and scaling skyscrapers. This is a partial list of thrill-seeking activities and subject to change.

**For coverage purposes, a professional athlete is a person who is on the team payroll of a professional sports organization like the NFL, NBA, MLB, etc.

In addition to the limitations and exclusions found in the Policy, this provision will also not provide benefits for the following:

Accident Medical Expense Exclusions:

  1. treatment by persons employed or retained by the Policyholder, or by any Immediate Family member or member of the Covered Person’s household.
  2. any elective treatment, surgery, health treatment, or examination.
  3. eyeglasses, contact lenses, hearing aids, wheelchairs, braces, appliances, examinations or prescriptions for them, or repair or replacement of existing artificial limbs,  orthopedic braces, or orthotic devices.
  4. charges for which the Covered Person would not be responsible in the absence of coverage under the Policy.
  5. expenses payable by any automobile insurance policy without regard to fault. (This exclusion does not apply in any state where prohibited).
  6. any treatment, service or supply not specifically covered by the Policy.
  7. routine dental care and treatment.
  8. rest cures or custodial care.

Broken Bones Exclusions:

  1. No benefit will be paid before any fracture is recognized medically and the extent and nature have been established by a Doctor.
  2. In the event that the Covered Person has received a benefit under this Rider, and the same bodily injury results in Death or Permanent Disablement, any benefits paid under this Rider will be deducted from the Death or Permanent Disablement benefit.
  3. Fractures for nose, teeth, wrists/hands/fingers and ankles/feet/toes are excluded from coverage.
  4. Chip fractures and stress fractures are excluded from coverage.