Plan Exclusions

The following general summary of the services not covered under this plan may vary according to the state in which the insured resides.

• Pre-existing conditions.
• Free services of a federal, veteran's, state or municipal hospital.
• Charges for the services of a standby physician except in limited circumstances.
• Charges for treatment of the covered person's intentionally self-inflicted illness or injury, whether sane or insane.
• Charges for treatment of an illness or injury caused by or contributed by: (a) worker's compensation or occupational disease laws; (b) the participation in the military service; (c) war or act of war, (d) attempt to commit a felony.
• Charges for treatment of an illness or injury that occurs while the covered person has been under the influence of illegal narcotics or non-prescribed controlled substance.
• Charges for cosmetic treatment or reconstructive or plastic surgery that is primarily a cosmetic procedure.
• Charges for hearing aids; eyeglasses; contact lenses; eye exams; eye refraction; eye surgery for correction of refraction error; corrective shoes; repairs to or replacement of prosthetic devices.
• Charges for normal pregnancy or childbirth, genetic testing, counseling or therapy including but not limited to, amniocentesis and chorionic villi testing; abortion, except as provided in the Complications of Pregnancy Provision; infertility treatment; artificial insemination; in-vitro fertilization; and sterilization or reversal of sterilization.
• Charges for treatment, medications or hormones to stimulate growth and any other treatment or surgery for weight control or obesity.
• Charges for treatment of mental disorders, mental illness or substance abuse.
• Charges for dental treatment unless a hospital stay is required due to injury.
• Charges for services rendered by or supplies purchased from a member of your immediate family.
• If the covered person is eligible for Medicare, that part of any charge for which a benefit would be paid under Medicare or any other government law or program (except Medicaid); or Medical coverage under any automobile insurance.
• Charges for treatment, repair or removal of the tonsils or adenoids, except on an emergency basis.
• Charges for living expenses; and travel or transportation expenses.
• Charges for treatment of chronic pain disorders; biofeedback; custodial care; self-help programs.
• Charges for experimental or investigational treatment.
• The first $2500 or 50% (whichever is the lesser amount) of otherwise covered charges not authorized in accordance with the Authorization Provision or any expense for bone marrow, heart, liver or kidney transplant if the procedure was not authorized prior to the beginning of the donor search and selection.
• Charges incurred after coverage terminates.
• Charges incurred outside the U.S. Canada, or U.S. possessions.

Although the above provides a good description of the important features of the Short Term Medical plan, this is not the insurance contract and only the actual contract defines coverage. Exclusions may vary by state and by the terms of the insurance contract. The policy itself sets forth in detail the rights and obligations of both you and the insurance company.

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