![]() Special braces, splints, specialized equipment, appliances, ambulatory apparatus, battery implants, except as specifically mentioned in this Certificate.ġ6. Personal hygiene, comfort or convenience items commonly used for other than medical purposes, such as air conditioners, humidifiers, physical fitness equipment, televisions and telephones.ġ5. Charges for failure to keep a scheduled visit or charges for completion of a Claim form.ġ4. Services or supplies for which you are not required to make payment or would have no legal obligation to pay if you did not have this or similar coverage.ġ3. Cosmetic Surgery and related services and supplies, whether or not for psychological purposes, except for the correction of congenital deformities or for conditions resulting from accidental injuries, scars, tumors or diseases that occur after your Coverage Date.ġ2. Services or supplies received during an Inpatient stay when the stay is primarily related to behavioral, social maladjustment, lack of discipline or other antisocial actions that are not specifically the result of Mental Illness.ġ1. Routine physical examinations, unless otherwise specified in this Certificate.ġ0. Investigational Services and Supplies and all related services and supplies.ĩ. Services or supplies that do not meet accepted standards of medical and/or dental practice.ħ. ![]() Conditions caused by or contributed by: (a) An act of war (b) The inadvertent release of nuclear energy when government funds are available for treatment of Illness or Injury arising from such release of nuclear energy (c) An Insured Person participating in the military service of any country (d) An Insured Person participating in an insurrection, rebellion, or riot (e) Services received for any condition caused by an Insured Person's commission of, or attempt to commit a felony or to which a contributing cause was the Insured Person being engaged in an illegal occupation (f) An Insured Person voluntarily using illegal drugs intentionally taking over the counter medication not in accordance with recommended dosage and warning instructions and intentionally misusing prescription drugs.Ħ. ![]() Services or supplies that are furnished to you by the local, state or federal government and for any services or supplies to the extent payment or benefits are provided or available from the local, state or federal government whether or not that payment or benefits are received.ĥ. Services or supplies for any illness or injury arising out of or in the course of employment for which benefits are available under any Worker's Compensation Law or other similar laws whether or not you make a claim for such compensation or receive such benefits.Ĥ. ![]() Services or supplies that are not specifically mentioned in this Certificate.ģ. Hospitalization, services and supplies that are not Medically Necessary.Ģ. Global Travel Benefits – Insurer Waives Deductibleġ. Optional Rider, subject to $25,000 maximum per Insured Person per Coverage Period. Prescription Drug Benefit Options – Insurer Waives Deductible Surgery, X-rays, In-hospital Doctor Visits, Organ/Tissue TransplantĪmbulatory and Therapeutic Services – Insurer Pays After Deductible is Met Inpatient Hospital Services – Insurer Pays After Deductible is Met Surgery, Anesthesia, Radiation Therapy, In-hospital Doctor Visits, Diagnostic X-ray and Lab Work. Professional Services – Insurer Pays After Deductible is Met Women (19 and Older) Routine Pap Smears, Annual Mammogram Preventive and Office Visits – Insurer Waives Deductible
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