The LIFEBOAT Medical Insurance Plan
DOES NOT COVER:
- Any injury or illness which meets
the following criteria:
- A condition that would have
caused a person to seek medical advice, diagnosis,
care or treatment prior to the Effective Date of
coverage under this Certificate.
- A condition for which medical
advice, diagnosis, care or treatment was recommended
or received prior to the Effective Date of coverage
under this Certificate.
However, Pre-existing
Conditions that ARE disclosed on the application
and accepted by the Company shall be considered covered.
Exclusionary Riders may be issued by the Company for
certain Pre-Existing Conditions.
- Pregnancy expenses, including
complications of pregnancy;
- Injury or illness which is not
presented to the Company for payment within ninety (90)
days immediately following the incident.
- Charges for treatment which is
not Medically Necessary.
- Charges provided at no cost to
the Insured Person.
- Charges for treatment which
exceed Reasonable and Customary charges.
- Charges incurred for Surgeries or
treatments which are investigational, Experimental, or
for research purposes.
- Services, supplies or treatment,
including any period of Hospital confinement, which were
not recommended, approved and certified as Medically
Necessary and reasonable by a Physician.
- Suicide or any attempt there at,
while sane or self destruction or any attempt there at,
while insane;
- Any consequence, whether directly
or indirectly, proximately or remotely occasioned by,
contributed to by, or traceable to, or arising in
connection with: a. war, invasion, act of foreign enemy
hostilities, warlike operations (whether war be declared
or not), or civil war. b. mutiny, riot, strike, military
or popular uprising insurrection, rebellion, revolution,
military or usurped power. c. any act of any person
acting on behalf of or in connection with any
organization with activities directed towards the
overthrow by force of the Government de jure or de facto
or to the influencing of it by terrorism or violence. d.
martial law or state of siege or any events or causes
which determine the proclamation or maintenance of
martial law or state of siege (hereinafter for the
purposes of this Exclusion called the "Occurrences").
- Injury sustained while
participating in professional athletics;
- Routine physicals, immunizations,
or other examinations where there are no objective
indications or impairment in normal health, and
laboratory diagnostic or x-ray examinations, except in
the course of a Disablement established by a prior call
or attendance of a Physician; or unless otherwise
covered under this Certificate;
- Treatment of the
Temporomandibular Joint.
- Vocational, Speech, Recreational
or Music Therapy.
- Services or supplies performed or
provided by a Relative of the Insured Person, or anyone
who lives with the Insured Person.
- Cosmetic or plastic Surgery,
except as the result of a covered Accident. For the
purposes of this Insurance, treatment of a deviated
nasal septum shall be considered a cosmetic condition.
- Treatment and the provision of
false teeth or dentures, normal ear tests and the
provision of hearing aids;
- Eye refractions or eye
examinations for the purpose of prescribing corrective
lenses for eye glasses or for the fitting thereof,
unless caused by Accidental Bodily Injury incurred while
insured hereunder;
- Injury sustained while under the
influence of or Disablement due wholly or partly to the
effects of intoxicating liquor or drugs, other than
drugs taken in accordance with treatment prescribed and
directed by a Physician for a condition which is covered
hereunder. No coverage for treatment of drug addiction.
- Telephone consultations or
failure to keep a scheduled appointment.
- Treatment while confined
primarily to receive Custodial Care, educational or
rehabilitative care, or nursing services.
- Congenital abnormalities and
conditions arising out of or resulting therefrom, unless
otherwise covered under this Certificate.
- Expenses which are non-medical in
nature.
- The cost of the Insured Person's
unused airline ticket for the transportation back to the
Insured Person's Home Country, where an Emergency
Medical Evacuation or Repatriation and/or Return of
Mortal Remains benefit is provided.
- Expenses as a result or in
connection with intentionally self-inflicted injury or
illness;
- Expenses as a result or in
connection with the commission of a felony offense;
- Injury sustained while taking
part in mountaineering where ropes or guides are
normally used, hang gliding, parachuting, bungee
jumping, racing by horse, motor or motorcycle, scuba
diving involving underwater breathing apparatus - unless
PADI, DAN (or other) Certification;
- Treatment paid for or furnished
under any other individual or group policy or other
service or medical pre-payment plan arranged through the
employer to the extent so furnished or paid, or under
any mandatory government program or facility set up for
treatment without cost to any individual;
- Injuries for which benefits are
payable under any no-fault automobile insurance policy;
- Treatment of Venereal disease,
sexually tranmitted disease, or expenses for a sex
change;
- Dental care, except as the result
of injury to sound, natural teeth caused by Accident;
- Routine Dental Treatment;
- Pregnancy expenses incurred by a
Dependent Child;
- Drug, treatment or procedure that
either promotes or prevents conception, or prevents
childbirth, including but not limited to: artificial
insemination, treatment for infertility or impotency,
sterilization or reversal thereof, or abortion.
Exclusions Regarding the AD&D
benefit are listed in the Certificate of Insurance.
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