|
2. Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury
<br />resulting from an Accident while the Covered Person is covered under this Certificate, and rendered within 6
<br />months of the Accident;
<br />3. Services or treatment rendered by a doctor, nurse or any other person who is:
<br />(a) Employed or retained by the Certificateholder; or
<br />(b) Who is the Covered Person or a member of his immediate family;
<br />4. Charges which:
<br />(a) The Covered Person would not have to pay if he did not have insurance; or
<br />(b) Are in excess of Usual, Reasonable and Customary charges.
<br />5. An Injury that is caused by flight In:
<br />(a) An aircraft, except as a fare -paying passenger;
<br />(b) A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or
<br />(c) An ultra light, hang-gliding, parachuting or bungi-cord jumping;
<br />6. Travel in or upon:
<br />(a) A snowmobile;
<br />(b) Any two or three wheeled motor vehicle;
<br />(c) Any off -road motorized vehicle not requiring licensing as a motor vehicle;
<br />7. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current
<br />and valid motor vehicle operator's license;
<br />8. That part of medical expense payable by any automobile Insurance policy without regard -to fault. (Does not
<br />apply in any state where prohibited);
<br />9. Injury that is:
<br />(a) The result of the Covered Person being Intoxicated. ("Intoxicated" will have the meaning determined by
<br />the laws in the jurisdiction of the geographical area where the loss occurs); or
<br />(b) Caused by any narcotic, drug, poison, gas or fumes voluntarily taken, administered, absorbed or Inhaled,
<br />unless prescribed by a doctor;
<br />10, Any Sickness, except infection which occurs directly from an Accidental cut or wound or diagnostic tests or
<br />treatment, or ingestion of contaminated food,
<br />11. Expenses to the extent that they are paid or payable under other valid and collectible group insurance or
<br />medical prepayment plan;
<br />12. Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood;
<br />13, Elective treatment or surgery, health treatment, or examination where no Injury is involved;
<br />14. Injury sustained while in the service of the armed forces of any country. When the Covered Person enters the
<br />armed forces of any country, we will refund the unearned pro rate premium upon request;
<br />15. Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions therefore;
<br />16. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;
<br />17, Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or
<br />abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration
<br />therapy;
<br />18. Cosmetic surgery, except for reconstructive surgery on a diseased or injured part of the body;
<br />19. Any loss which is covered by state or federal worker's compensation, employers liability, occupational
<br />disease law, or similar laws;
<br />20. The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices;
<br />21. Rest cures or custodial care;
<br />22, The repair or replacement of existing dentures, partial dentures, braces or fixed or removable bridges;
<br />23. Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits;
<br />24. Orthopedic appliances which are used mainly to protect an Injury so that a covered student can take part in
<br />Interscholastic or intercollegiate sports;
<br />25. Services and supplies furnished by the Policyholder's infirmary, Its employees, or doctors who work for the
<br />Policyholder's;
<br />26, Hernia of any kind; or any bacterial infection that was not caused by an Accidental cut or wound;
<br />27. Prescription medicines unless specifically provided for under this Certificate.
<br />LIMITATIONS
<br />Any benefits payable under this Certificate will be limited to the following:
<br />(1) The medical benefits otherwise payable under this Certificate will be reduced by 50% if: ,,jq\
<br />GAC26932
<br />
|