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Loyal American Life Insurance Company Protection Plus - Hospital Confinement Exclusions and Limitations
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AK, AL, AZ, CO, DC, DE, IL, KS, LA, MS, ND, NE, NV, OH, RI, SC, TN, UT, WI, WY
EXCLUSIONS AND LIMITATIONS
Benefits are not provided for:
- Mental, nervous, psychotic or psychoneurotic defi ciencies or disorders without demonstrable organic disease;
- Alcoholism, drug addition or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician)1;
- Attempt at suicide or intentionally self-infl icted injury2;
- Treatment provided in a Veteran’s Administration or government facility, unless you or your estate are charged for the Confi nement3;
- Confi nement or care provided outside the United States;
- Services rendered by a family member while confi ned or for which no charge is made in the absence of insurance;
- Confi nement resulting from war or any act of war, declared or undeclared;
- Any expense or Loss that is incurred while this policy is not in force.
Preexisting Condition Limitation - A preexisting condition is a condition for which medical advice was given or treatment was recommended by a physician within six (6) months before the policy date. If the loss occurs within the fi rst six (6) months aft er the policy date, benefi ts are not payable if the loss is due to a pre-existing condition.
Renewal Provision - Guaranteed Renewable For Life, we guarantee to renew your policy each time you send us the premium. It must be paid on or before the date it is due or during the thirty-one (31)4 days that follow. Your policy stays in force during this time.
Subject To Change - Your premiums will not increase because of a change in your health. We can only change your premium when we make the same change to all policies of this form in your state. We will send you written notice at least thirty-one (31) days in advance of any premium change. Premiums and benefi ts will vary with the choice of benefi ts selected.
This Is Not Medicare Supplement Coverage - If you are eligible for Medicare, review the Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare available from us, your agent or at www.cms.gov.
1 Not applicable in Indiana & Pennsylvania.
2 Not applicable while insane in Missouri.
3 Not applicable in Iowa, Maine, Missouri, Pennsylvania & West Virginia.
4 Sixty (60) days in Wisconsin.
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AR, TX, VA, WA
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
- mental, nervous, psychotic or psychoneurotic deficiencies or disorders without demonstrable organic disease; or
- alcoholism, drug addiction, or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide or intentionally self-inflicted injury; or
- treatment provided in a veteran's administration or government facility, unless you or your estate are charged for the confinement; or
- services rendered by a family member while confined or for which no charge is made in the absence of insurance; or
- confinement resulting from war or any act of war, declared or undeclared; or
- any expense or loss that is incurred while this policy is not in-force: or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
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IA, ME, WV
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
-
mental, nervous, psychotic or psychoneurotic deficiencies or disorders without demonstrable organic disease; or
- alcoholism, drug addiction, or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide or intentionally self inflicted injury; or
- services rendered by a family member while confined or for which no charge is made in the absence of insurance; or
- confinement resulting from war or any act of war, declared or undeclared; or
- any expense or loss that is incurred while this policy is not in-force: or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION
Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
The First Diagnosis of Cancer Benefit Rider provides benefits only for the first diagnosis of cancer as defined in the rider. No benefit is payable for the diagnosis of skin cancer, carcinoma-in-situ, premalignant conditions or conditions with malignant potential, including, but not limited to severe cervical dysplasia (Class III and IV) and CIN (cervical intraepithelial neoplasm). The rider does not provide benefits for any other disease, sickness or incapacity.
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MO
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
-
mental, nervous, psychotic or psychoneurotic deficiencies or disorders without demonstrable organic disease; or
- alcoholism, drug addiction, or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide while sane or intentionally self-inflicted injury; or
- services rendered by a family member while confined; or
- confinement resulting from war or any act of war, declared or undeclared; or
- any expense or loss that is incurred while this policy is not in-force: or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
The First Diagnosis of Cancer Benefit Rider provides benefits only for the first diagnosis of cancer as defined in the rider. No benefit is payable for the diagnosis of skin cancer, carcinoma-in-situ, premalignant conditions or conditions with malignant potential, including, but not limited to severe cervical dysplasia (Class III and IV) and CIN (cervical intraepithelial neoplasm). The rider does not provide benefits for any other disease, sickness or incapacity.
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MT
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
- mental, nervous, psychotic or psychoneurotic deficiencies or disorders without demonstrable organic disease; ; (The policy will however, cover qualifying confinements or care resulting from severe mental illness); or
- alcoholism, drug addiction, or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide or intentionally self-inflicted injury; or
- treatment provided in a veteran's administration or government facility, unless you or your estate are charged for the confinement; or
- services rendered by a family member while confined or for which no charge is made in the absence of insurance; or
- confinement resulting from war or any act of war, declared or undeclared; or
- any expense or loss that is incurred while this policy is not in-force: or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
The First Diagnosis of Cancer Benefit Rider provides benefits only for the first diagnosis of cancer as defined in the rider. No benefit is payable for the diagnosis of skin cancer, carcinoma-in-situ, premalignant conditions or conditions with malignant potential, including, but not limited to severe cervical dysplasia (Class III and IV) and CIN (cervical intraepithelial neoplasm). The rider does not provide benefits for any other disease, sickness or incapacity.
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OK
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
- mental or emotional disorders ; or
- alcoholism or drug addiction (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide or intentionally self inflicted injury; or
- treatment provided in a veteran's administration or government facility, unless you or your estate are charged for the confinement; or
- services rendered by a family member while confined or for which no charge is made in the absence of insurance; or
- confinement resulting from war or any act of war, declared or undeclared while serving in the military forces or any auxiliary unit attached thereto; or
- any expense or loss that is incurred while this policy is not in-force:;or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
The First Diagnosis of Cancer Benefit Rider provides benefits only for the first diagnosis of cancer as defined in the rider. No benefit is payable for the diagnosis of skin cancer, carcinoma-in-situ, premalignant conditions or conditions with malignant potential, including, but not limited to severe cervical dysplasia (Class III and IV) and CIN (cervical intraepithelial neoplasm). The rider does not provide benefits for any other disease, sickness or incapacity.
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SD
EXCLUSIONS AND LIMITATIONS
This policy will NOT pay benefits for:
- mental, nervous, psychotic or psychoneurotic deficiencies or disorders without demonstrable organic disease; or
- treatment for alcoholism, drug addiction, or chemical dependency (unless the drug addiction or chemical dependency is a result of medication prescribed by a physician); or
- attempt at suicide or intentionally self inflicted injury; or
- treatment provided in a veteran's administration or government facility, unless you or your estate are charged for the confinement; or
- services rendered by a family member while confined (unless the family member is acting within the scope of their normal employment) or for which no charge is made in the absence of insurance; or
- confinement resulting from war or any act of war, declared or undeclared; or
- any expense or loss that is incurred while this policy is not in-force: or
- confinement or care provided outside of the United States.
PRE-EXISTING CONDITION PROVISION Benefits are not payable under this policy for loss due to a pre-existing condition if the loss occurs within the first 6 months after the policy date. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by a physician within 6 months before the policy date. Conditions fully disclosed on the application are covered subject to the time limit on certain defenses provision of the policy.
The First Diagnosis of Cancer Benefit Rider provides benefits only for the diagnosis of cancer as defined in the rider. No benefit is payable for the diagnosis of skin cancer, carcinoma-in-situ, premalignant conditions or conditions with malignant potential, including, but not limited to severe cervical dysplasia (Class III and IV) and CIN (cervical intraepithelial neoplasm). The rider does not provide benefits for any other disease, sickness or incapacity.
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Loyal-11-0004-GG
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