AL, AR, AZ, CO, GA, IA, IL, IN, KS, KY, MI, MO, MS, MT, ND, NH, NM, OH, OK, OR, SD, TX, UT, VA, WV    

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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ID

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in the policy;
6. Expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION:  A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage.  This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage.  If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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MN

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare. The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. The policy will not pay benefits for the following:

1. Any expense which you are not obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. Expense resulting from a pre-existing condition is not covered unless it is incurred 6 months or more after the coverage effective date. A pre-existing condition is one: (a) for which medical advice was given or treatment was recommended by or received from a physician within 90 days or less before your coverage effective date; and (b) which would not have caused us to deny issuing your policy had it been named on your application.

This provision does not apply if, as of the date of application, you had a continuous period of creditable coverage or had prior coverage under a Medicare supplement policy for at least six (6) months. If, as of the date of application, you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied. This provision does not apply if you applied for and were issued this policy under guaranteed issue status. 

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NC
EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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NE

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare. The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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PA, SC

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION:  A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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TN

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in the policy;
6. Confinement that begins or expenses incurred while the policy is not in force; or

LIMITATIONS (PRE-EXISTING CONDITION):  A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for the policy.
If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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WI

EXCLUSIONS AND LIMITATIONS

The benefits of the policy will not duplicate any benefits paid by Medicare.  The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred.  The policy will not pay benefits for the following:

1. Nursing home care costs beyond what is covered by Medicare and the Wisconsin mandated 30-day skilled nursing benefit;
2. Home health care visits above the number of visits covered by Medicare and the 40 visits shown, in the policy, unless the optional Additional Home Health Care Rider is purchased.
3. Physician charges above Medicare’s approved charge, unless the optional Medicare Part B Excess Charges Rider is purchased;
4. Outpatient prescription drugs;
5. Most care received outside the USA, unless the optional Foreign Travel Emergency Rider is purchased;
6. Dental care (except anesthesia charges for dental care provided in a hospital or ambulatory surgery center), dentures, checkups, routine immunizations, cosmetic surgery, routine foot care, examinations for and the cost of eyeglasses or hearing aids, unless eligible by Medicare;
7. Any expense incurred in excess of the usual and customary charge or not medically necessary as determined by us for all required Wisconsin mandated benefits;
8. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
9. Any services that are not medically necessary as determined by Medicare;
10. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
11. Any type of expense not a Medicare eligible expense except as provided in the policy;
12. PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least six (6) months of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for the policy.

If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

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WY

The benefits of the policy will not duplicate any benefits paid by Medicare. The combined benefits of the policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. The policy will not pay benefits for the following:

1. Any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
2. Any services that are not medically necessary as determined by Medicare;
3. Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);
4. Any type of expense not a Medicare eligible expense except as provided in the policy;
5. Any deductible, co-insurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in the policy;
6. Confinement that begins or expenses incurred while your policy is not in force; or
7. PRE-EXISTING CONDITION: A condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days prior to the policy effective date.

We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first ninety (90) days from the effective date of coverage. This exclusion does not apply if you applied for and were issued the policy under guaranteed issue status; if on the date of application for the policy you had at least ninety (90) days of prior creditable coverage; or, if the policy is replacing another Medicare supplement policy and a ninety (90) day waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for the policy.
If you had less than ninety (90) days prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If the policy is replacing another Medicare supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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