United Teacher Associates Insurance Company Heart Treatment Policy Exceptions and Limitations

AK, HI, KS, KY, LA, NE, NM, NV, OH, TN, WY

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Beneftis will not be paid for any diagnosis resulting from Pre-Existing condition(s).

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy.


 

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AL

 

EXCEPTIONS AND LIMITATIONS

 

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

 

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

 

PRE-EXISTING CONDITION LIMITATIONSBeneftis will not be paid for any diagnosis resulting from Pre-Existing condition(s).

 

 

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given five (5) years prior to the Effective Date of the policy. Benefits for a Pre-Existing Condition will be excluded for two (2) years from the Effective Date of the policy.


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CA

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, HeartDisease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for two (2) years from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy.


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CO

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for HeartAttack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment;  or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for two (2) years from the Effective Date of this policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, within the twelve (12) months prior to the Effective Date of the policy.


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IA

EXCEPTIONS AND LIMITATIONS

The policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke, as defined in this policy. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the effective date of coverage

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for twelve (12) months from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease which would have caused an ordinarily prudent person to have sought diagnosis, care or treatment within a five (5) year period prior to the Effective Date of the policy or a condition for which medical advice or treatment was recommended by a Physician or received from a Physician within a five (5) year period prior to the Effective Date.


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ID

EXCEPTIONS AND LIMITATIONS

After a 30-day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke, as defined in this policy. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-existing Condition will be excluded for twelve (12) months from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which medical advice, diagnosis, care or treatment was recommended or received from a physician within the six (6) month period preceding the effective date of the policy.


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IL

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. care and treatment received outside the United States;
  4. treatment not approved by a Physician as medically necessary;
  5. experimental treatment; or
  6. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for two (2) years from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given within the twenty-four (24) months prior to the Effective Date of the policy.


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IN

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke, as defined in this policy. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for eighteen (18) months from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, within the twelve (12) months prior to the Effective Date of the policy.

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MI, OK


EXCEPTIONS AND LIMITATIONS

 

The policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

 

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the e

 

PRE-EXISTING CONDITION LIMITATIONS
Beneftis will not be paid for any diagnosis resulting from Pre-Existing condition(s).

 

 

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy.


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MO

EXCEPTIONS AND LIMITATIONS

The policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the Effective Date.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded to two (2) years from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy.


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MS

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke.  It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment;  or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for twelve (12) months from the Effective Date of the Policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, within the twelve (12) months prior to the Effective Date of the policy.


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MT

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease  or Stroke.  It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment;  or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for twelve (12) months from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, within the five (5) years prior to the Effective Date of the policy.


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NC

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for twelve (12) months from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease which was diagnosed, for which medical advice was given or for which treatment was recommended or received within the twelve (12) months prior to the Effective Date of the policy.


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OR

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for two (2) years from the Effective Date of the policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given within the five (5) years prior to the Effective Date of the policy.


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SC

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease  or Stroke. It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. care and treatment received outside the United States;
  4. treatment not approved by a Physician as medically necessary;
  5. experimental treatment;  or
  6. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

During the first two (2) years after the Effective Date, this policy does not cover any diagnosis resulting from a Pre-Existing Condition.

PRE-EXISTING CONDITION means a condition misstated or not revealed which: (a) manifests itself prior to the Effective Date of the policy; or (b) was diagnosed by a Physician prior to the Effective Date of the policy and for which medical advice or treatment was recommended by or received from a Physician prior to the Effective Date of the policy.

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SD

EXCEPTIONS AND LIMITATIONS

The policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease  or Stroke.  It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment;  or
  7. Hospital confinement or expenses that are incurred prior to the Effective Date regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits will not be paid for any diagnosis resulting from Pre-Existing Condition(s).

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, within the two (2) years prior to the Effective Date of the policy.


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TX

EXCEPTIONS AND LIMITATIONS

The policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease or Stroke. It does not cover:

  1. Any other disease or sickness;
  2. Injuries;
  3. Any disease or incapacity that has been caused, complicated, worsened, or effected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. Care and treatment received outside the United States, when care and treatment are not subjects of ongoing clinical studies by the United States Food and Drug Administration for treatment of a Heart Attack, Heart Disease or Stroke;
  5. Treatment not approved by a Doctor as medically necessary;
  6. Experimental treatment; or
  7. Hospital confinement or expenses that are incurred before the Effective Date of coverage despite the date of positive diagnosis.

"Medically necessary" means medical treatment as prescribed by a Doctor that is needed by You, and is customarily applied to the treatment of Heart Attack, Heart Disease or Stroke.


PRE-EXISTING CONDITION LIMITATIONS

No benefits will be payable during the first twelve (12) months that coverage is in force for a Pre-Existing Condition.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, within the five (5) years prior to the Effective Date of the policy.


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WI

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease  or Stroke.  It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for Heart Attack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment;  or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Any Pre-Existing Condition not disclosed on the application will be excluded for two (2) years from the effective date of coverage.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy.

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WV

EXCEPTIONS AND LIMITATIONS

After a 30 day waiting period, the policy provides benefits only for loss resulting exclusively from Heart Attack, Heart Disease  or Stroke.  It does not cover:

  1. any other disease or sickness;
  2. injuries;
  3. any disease or incapacity that has been caused, complicated, worsened, or affected by Heart Attack, Heart Disease or Stroke or as a result of treatment for HeartAttack, Heart Disease or Stroke;
  4. care and treatment received outside the United States;
  5. treatment not approved by a Physician as medically necessary;
  6. experimental treatment; or
  7. Hospital confinement or expenses that are incurred prior to the end of the Waiting Period regardless of the date of first positive diagnosis.

PRE-EXISTING CONDITION LIMITATIONS

Benefits for a Pre-Existing Condition will be excluded for twelve (12) months from the Effective Date of the Policy.

PRE-EXISTING CONDITION means a Heart Attack or Heart Disease for which diagnosis, advice or treatment is given, or for which signs or symptoms existed which would have caused an ordinarily prudent person to have sought diagnosis, advice or treatment, prior to the Effective Date of the policy. 


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