Loyal American Life Insurance Company Affordable Health Benefits® Exclusions and Limitations
           
AL, IA, IN, LA, MI, MO, MS, NV, OH, SD, SC, TN, WI, WV 

WHAT ISN'T COVERED: 

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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CO

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. a) non-medical items, self-care or self-help programs;
    2. b) aroma therapy;
    3. c) meditation or relaxation therapy;
    4. d) naturopathic medicine;
    5. e) treatment of hyperhidrosis (excessive sweating);
    6. f) acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. g) Inpatient treatment of chronic pain disorders;
    8. h) treatment of spider veins;
    9. i) family or marriage counseling;
    10. j) applied behavior therapy treatment for autistic spectrum disorders;
    11. k) smoking deterrence or cessation;
    12. l) snoring or sleep disorders;
    13. m) change in skin coloring or pigmentation; or
    14. n) stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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 GA

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits. This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. (anti-cancer drugs are not excluded under this item if (a) the drug is recognized for treatment of cancer in at least one standard reference compendium or (b) the drug is recommended for a particular type of cancer and found to be safe and effective in formal clinical studies, the results of which have been published in a peer review professional medical journal published in either the United States or Great Britain.)
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 

IL

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting directly from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause of his or her Injury or Sickness;
  10. committing or attempting to commit a felony or engaging in an illegal occupation;
  11. complications of a non-covered service;
  12. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  13. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  14. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  15. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  16. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  17. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  18. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  19. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  20. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  21. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  22. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  23. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  24. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  25. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  26. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  27. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  28. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  29. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  30. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  31. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  32. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  33. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
KY

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions: flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
 NC

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. services or supplies for the treatment of an Occupational Injury or Sickness which are paid under the North Carolina Workers’ Compensation Act only to the extent such services or supplies are the liability of the employee, employer or workers’ compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ Compensation Act.
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. diagnostic, therapeutic, or surgical procedures involving any bone or joint of the jaw, face or head, except when they are medically necessary to treat a condition which prevents normal functioning of the particular bone or joint involved and the condition is caused by congenital deformity, disease or traumatic injury;
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
NE

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

 We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in an organized race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
NM

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first six (6) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the six (6) months prior to the Effective Date of coverage.

 We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
OK

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane;
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or drug addiction;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war while serving in the military or an auxiliary unit attached to the military or working in an area of war whether voluntarily or as required by an employer;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being under the influence of any narcotic unless administered under the advice of a Physician;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. as a result of certain aviation activities;
  12. complications of a non-covered service;
  13. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  14. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  15. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  16. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  17. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  18. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  19. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  20. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  21. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  22. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  23. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  24. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  25. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  26. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  27. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  28. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  29. spinal and other adjustments, manipulations, subluxation treatment and/or services;
  30. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  31. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  32. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  33. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  34. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
OR

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. committing or attempting to commit a felony , if convicted of such felony  or engaging in an illegal occupation or activity;
  10. participation in any sport or sporting activity for wage, compensation or profit;
  11. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  12. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  13. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  14. complications of a non-covered service;
  15. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  16. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  17. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  18. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  19. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  20. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  21. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  22. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  23. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  24. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  25. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  26. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  27. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  28. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  29. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  30. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  31. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  32. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  33. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  34. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  35. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  36. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

Back To Top 
SD

WHAT ISN'T COVERED

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the Effective Date of the policy.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is paid benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. an act of declared or undeclared war;
  6. care and treatment received outside the United States or its territories;
  7. participation in the military service of any country or international organization;
  8. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  9. participation in any sport or sporting activity for wage, compensation or profit;
  10. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  11. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  12. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  13. complications of a non-covered service;
  14. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  15. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  16. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  17. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  18. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  19. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  20. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  21. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  22. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  23. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  24. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  25. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  26. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  27. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  28. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  29. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  30. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  31. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  32. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  33. abuse or overdose of any illegal or controlled substance if the Insured Person is committing a felony at the time of loss;
  34. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  35. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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TX

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.
GENERAL EXCLUSIONS applicable to all coverage.

WHAT WE WILL NOT PAY FOR: We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following: 
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. an act of declared or undeclared war; 
  3. suicide, while sane or any attempt or threat to commit; 
  4. intentionally self-inflicted Injury (not applicable to Sickness); 
  5. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity; 
  6. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician; 
  7. committing or attempting to commit a felony or engaging in an illegal occupation or activity; 
  8. participation in the military service of any country or international organization; or 
  9. loss that begins prior to the Effective Date of coverage. 
EXCLUSIONS applicable only to the base policy – WHAT WE WILL NOT PAY FOR: We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:  
  1. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency; 
  2. complications of a non-covered service; 
  3. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine; 
  4. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension; 
  5. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices (including orthotics and corrective shoes), foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  6. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  7. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw); 
  8. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling; 
  9. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation; 
  10. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us; 
  11. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas; 
  12. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of this policy; 
  13. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date; 
  14. treatment, services, and supplies for: 
    1. Home Health Care; 
    2. Hospice Care; 
    3. Skilled Nursing Facility care, Inpatient rehabilitation services; 
    4. Custodial Care, respite care, rest care, supportive care, homemaker services; 
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician; 
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider; 
    7. treatment or services provided by a standby Physician; or 
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer; 
  15. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth; 
  16. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire; 
  17. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care; 
  18. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to: 
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing; 
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception; 
    3. sterilization; 
    4. cyropreservation of sperm or eggs; 
    5. surrogate pregnancy; 
    6. fetal surgery, treatment or services; 
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury;  
    8. circumcision; or 
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term; 
  19. spinal and other adjustments, manipulations, subluxation treatment and/or services; 
  20. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials; 
  21. treatment for or through the use of: 
    1. non-medical items, self-care or self-help programs; 
    2. aroma therapy;
    3. meditation or relaxation therapy; 
    4. naturopathic medicine; 
    5. treatment of hyperhidrosis (excessive sweating); 
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation; 
    7. Inpatient treatment of chronic pain disorders; 
    8. treatment of spider veins; i) family or marriage counseling; 
    9. applied behavior therapy treatment for autistic spectrum disorders; 
    10. smoking deterrence or cessation; 
    11. snoring or sleep disorders; 
    12. change in skin coloring or pigmentation; or 
    13. stress management; 
  22. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or 
  23. treatment, services and supplies for Experimental or Investigational Services.
EXCLUSIONS applicable only to the Accidental Death & Dismemberment rider - WHAT WE WILL NOT PAY FOR: 
  1. participation in any sport or sporting activity for wage, compensation or profit; 
  2. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.   Aircraft includes those which are not motor driven; 
  3. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning; 
  4. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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UT

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

  1. We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  2. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  3. intentionally self-inflicted;
  4. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  5. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  6. loss that begins prior to the Effective Date of coverage;
  7. an act of declared or undeclared war;
  8. care and treatment received outside the United States or its territories;
  9. participation in the military service of any country or international organization;
  10. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  11. an Insured Person’s voluntary participation in committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  12. participation in any sport or sporting activity for wage, compensation or profit;
  13. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  14. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  15. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  16. complications of a non-covered service;
  17. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  18. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  19. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  20. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  21. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  22. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  23. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  24. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  25. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  26. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  27. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  28. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  29. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  30. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  31. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  32. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  33. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  34. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  35. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  36. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  37. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  38. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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VA

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the twelve (12) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization. Upon written request, we will refund premiums, on a pro rata basis, if an Insured Person is on active duty in the military service of any country or international organization;
  9. an Insured Person’s being drunk, or under the influence of any narcotic taken on the advice of a Physician.  The Insured Person’s drunkenness or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation;
  11. operating, learning to operate, serving as a crew member of any aircraft.  Aircraft includes those which are not motor driven;
  12. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  13. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  14. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  15. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  16. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  17. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  18. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  19. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  20. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas or reconstructive surgery incidental to or following surgery resulting from trauma;
  21. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  22. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  23. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  24. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  25. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  26. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care. Treatment, services and supplies related to pregnancy following an act of rape of an Insured Person, which was reported to the police within seven (7) days following its occurrence, will be covered to the same extent as any other Sickness (the seven-day (7) requirement will be extended to 180 days in the case of an act of rape or incest of a female under thirteen (13) years of age);
  27. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  28. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  29. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  30. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    6. treatment of spider veins;
    7. family or marriage counseling;
    8. applied behavior therapy treatment for autistic spectrum disorders;
    9. smoking deterrence or cessation;
    10. snoring disorders;
    11. change in skin coloring or pigmentation; or
    12. stress management;
  31. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, or an Immediate Family member, of an Insured Person or a person ; or
  32. services or supplies for which no charge is normally made in the absence of insurance; or
  33. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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WY

WHAT ISN'T COVERED:

PRE-EXISTING CONDITION(S): The benefits of the policy will not be payable during the first twelve (12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-Existing Condition(s). A Pre-Existing Condition(s) means any condition diagnosed or for which medical advice or treatment was recommended by or received from a Physician within the six (6) months prior to the Effective Date of coverage.

We will not pay benefits for any Sickness or Injury resulting, whether directly or indirectly, from any of the following:
  1. a work-related condition that is eligible for benefits under Workman’s Compensation, Employers’ Liability or similar laws even when the Insured Person does not file a claim for benefits.  This exclusion will not apply to an Insured Person who is not required to have coverage under any Workman’s Compensation, Employers’ Liability or similar law and does not have such coverage; 
  2. intentionally self-inflicted;
  3. suicide or attempted suicide, while sane or insane(while sane only in Missouri);
  4. treatment of Mental or Nervous Disorders without demonstrable organic disease, alcoholism or chemical dependency;
  5. loss that begins prior to the Effective Date of coverage;
  6. an act of declared or undeclared war;
  7. care and treatment received outside the United States or its territories;
  8. participation in the military service of any country or international organization;
  9. an Insured Person’s being intoxicated, as determined and defined by the laws and jurisdiction of the geographical area in which the Injury or Sickness or cause of Injury or Sickness was incurred, or under the influence of any narcotic unless administered under the advice of a Physician.  The Insured Person’s alcohol or narcotic impairment must be the cause or contributing cause of his or her Injury or Sickness, irrespective of whether the Injury or Sickness occurred while the Insured Person was driving a motor vehicle or engaged in any other activity;
  10. committing or attempting to commit a felony or engaging in an illegal occupation or activity;
  11. participation in any sport or sporting activity for wage, compensation or profit;
  12. operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft.  Aircraft includes those which are not motor driven;
  13. engaging in hang gliding, bungee jumping, parachuting, sail gliding, parakiting, or hot air ballooning;
  14. riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  15. complications of a non-covered service;
  16. glasses, contact lenses, vision therapy, exercise or training, surgery including any complications arising therefrom to correct visual acuity including, but not limited to, lasik and other laser surgery, radial keratotomy services or surgery to correct astigmatism, nearsightedness (myopia) and/or farsightedness (presbyopia); vision care that is routine;
  17. hearing care that is routine; any artificial hearing device, cochlear implant, auditory prostheses or other electrical, digital, mechanical or surgical means of enhancing, creating or restoring auditory comprehension;
  18. treatment for foot conditions including, but not limited to:  flat foot conditions, foot supportive devices including orthotics and corrective shoes, foot subluxation treatment, corns, bunions, calluses, toenails, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, or hygienic foot care that is routine; 
  19. dental treatment, dental care that is routine, bridges, crowns, caps, dentures, dental implants or other dental prostheses, dental braces or dental appliances, extraction of teeth, orthodontic treatment, odontogenic cysts, any other treatment or complication of teeth and gum tissue, except as otherwise covered for a Dental Injury; 
  20. treatment of TMJ (Temporomandibular Joint) Dysfunction and CMJ (Craniomandibular Joint) Dysfunction; any appliance, medical or surgical treatment for malocclusion (teeth that do not fit together properly which creates a bite problem), protrusion or recession of the mandible (a large chin which causes an underbite or a small chin which causes an overbite), maxillary or mandibular hyperplasia (excess growth of the upper or lower jaw) or maxillary or mandibular hypoplasia (undergrowth of the upper or lower jaw);
  21. any treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Insured Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is appropriate or regardless of potential benefits for co-morbid conditions, weight reduction or weight control surgery, treatment or programs, any type of gastric bypass surgery, suction lipectomy, physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling;
  22. organ, tissue or cellular material donation by an Insured Person, including administrative visits for registry, computer search for donor matches, preliminary donor typing, donor counseling, donor identification and donor activation;
  23. chemical peels, reconstructive or plastic surgery that does not alleviate a functional impairment and other confinement or treatment visits that are primarily for Cosmetic Services as determined by Us;
  24. capsular contraction, augmentation or reduction mammoplasty.  This does not apply to all stages and revisions of reconstruction of the breast following a mastectomy for the treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and treatment of lymphedemas;
  25. removal or replacement of a prosthesis, Durable Medical Equipment or Personal Medical Equipment.  This does not apply to an internal breast prostheses following a mastectomy for the treatment of Cancer and services are received in accordance with the benefit provisions of the policy;
  26. prophylactic treatment, services or surgery including, but not limited to, prophylactic mastectomy or any other treatment, services or surgery to prevent a disease process from becoming evident in the organ or tissue at a later date;
  27. treatment, services, and supplies for:
    1. Home Health Care;
    2. Hospice Care;
    3. Skilled Nursing Facility care, Inpatient rehabilitation services;
    4. Custodial Care, respite care, rest care, supportive care, homemaker services;
    5. phone, facsimile, internet or e-mail consultation, compressed digital interactive video, audio or clinical data transmission using computer imaging by way of still-image capture and store forward; including telemedicine services or telehealth services or technology that facilitates access to a Physician;
    6. treatment, services or supplies that are furnished primarily for the personal comfort or convenience of the Insured Person, Insured Person’s family, a Physician or provider;
    7. treatment or services provided by a standby Physician; or
    8. treatment or services provided by a masseur, masseuse or massage therapist, massage therapy, or a rolfer;
  28. treatment, services, and supplies for growth hormone therapy, including growth hormone medication and its derivatives or other drugs used to stimulate, promote or delay growth or to delay puberty to allow for increased growth;
  29. treatment, services and supplies related to the following conditions, regardless of underlying causes:  sex transformation, gender dysphoric disorder, gender reassignment, and treatment of sexual function, dysfunction or inadequacy, treatment to enhance, restore or improve sexual energy, performance or desire;
  30. treatment, services and supplies related to: maternity, routine pregnancy (however Complication(s) of Pregnancy will be covered in the same manner as any other Sickness), routine well newborn care at birth including nursery care;
  31. any treatment or procedure that promotes or prevents conception or prevents childbirth, including but not limited to:
    1. genetic testing or counseling, genetic services and related procedures for screening purposes including, but not limited to, amniocentesis and chorionic villi testing;
    2. services, drugs or medicines used to treat males or females for an infertility diagnosis regardless of intended use including, but not limited to: artificial insemination, in vitro fertilization, reversal of reproductive sterilization, any treatment to promote conception;
    3. sterilization;
    4. cyropreservation of sperm or eggs;
    5. surrogate pregnancy;
    6. fetal surgery, treatment or services;
    7. umbilical cord stem cell or other blood component harvest and storage in the absence of a Sickness or an Injury; 
    8. circumcision; or
    9. abortion, unless the life of the mother would be endangered if the fetus were carried to term;
  32. spinal and other adjustments, manipulations, subluxation treatment and/or services. Not applicable in Louisiana;
  33. treatment for: behavior modification or behavioral (conduct) problems; learning disabilities, developmental delays, attention deficit disorders, hyperactivity, educational testing, training or materials;
  34. treatment for or through the use of:
    1. non-medical items, self-care or self-help programs;
    2. aroma therapy;
    3. meditation or relaxation therapy;
    4. naturopathic medicine;
    5. treatment of hyperhidrosis (excessive sweating);
    6. acupuncture, biofeedback, neurotherapy, electrical stimulation;
    7. Inpatient treatment of chronic pain disorders;
    8. treatment of spider veins;
    9. family or marriage counseling;
    10. applied behavior therapy treatment for autistic spectrum disorders;
    11. smoking deterrence or cessation;
    12. snoring or sleep disorders;
    13. change in skin coloring or pigmentation; or
    14. stress management;
  35. abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Insured Person’s Physician;
  36. services ordered, directed or performed by a Physician or supplies purchased from a Medical Supply Provider who is an Insured Person, an Immediate Family member, employer of an Insured Person or a person who ordinarily resides with an Insured Person; or
  37. treatment, services and supplies for Experimental or Investigational Services. 
This brochure is designed as a marketing aid and is not to be construed as a contract for a Hospital Confinement and Surgical Fixed Indemnity policy. It provides a brief description of the important features of policy form series LY-HS-BA. The full terms and conditions of coverage are stated in and governed by an issued policy and riders. Availability may vary by state.

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Loyal-11-0004-AA

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