Benefit Reductions, Common Exclusions and Limitations: thereat while sane or insane; • commission or attempt to commit a felony or an assault; • declared or undeclared war or act of war; • a Covered Loss that results from active duty service in the military, naval or air force of any country or international organization (upon our receipt of proof of service, we will refund any premium paid for this time; Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days); • voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; • operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant (‘’Under the influence of alcohol’’, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Loss occurred)• a diagnosis not in accordance with generally accepted medical principles prevailing in the United States at the time of the diagnosis. Specific Definitions, Benefit Exclusions and Limitations: The date of diagnosis must occur while coverage is in force and the condition definition must be satisfied. Only one Initial Benefit will be paid for each Covered Condition per person. Skin Cancer, basal cell/squamous cell carcinoma or certain forms of melanoma. Invasive Cancer, uncontrolled/abnormal growth or spread of invasive malignant cells. Excludes pre-malignant conditions or conditions with malignant potential. Carcinoma in Situ, non-invasive malignant tumor. Excludes premalignant conditions or conditions with malignant potential, skin cancers, invasive cancer (basal/squamous cell carcinoma or melanoma/melanoma in situ). Heart Attack, includes the following that confirms permanent loss of heart muscle function: 1) EKG; 2) elevation of cardia enzyme. Must have an inpatient admission. Stroke, cerebrovascular event–for instance, cerebral hemorrhage–confirmed by neuroimaging studies and neurological deficits lasting 96 hours or more. Excludes transient ischemic attack (TIAs), brain injury related to trauma or infection, brain injury associated with hypoxia or anoxia, vascular disease affecting eye or optic nerve or ischemic disorders of the vestibular system. Must have an inpatient admission. Coronary Artery Disease, heart disease/angina resulting in a blockage that restricts blood flow to the heart. Advanced Stage Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in cognitive deficits interfering with independence in completion of instrumental activities of daily living and may also require the inability to perform at least 2 physical activities of daily living. Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrig’s Disease), motor neuron disease resulting in muscular weakness and atrophy. Parkinson’s Disease, progressive, degenerative neurologic disease with indicated signs of the disease. Multiple Sclerosis, disease involving damage to brain and spinal cord cells with signs of motor or sensory deficits confirmed by MRI. Includes Neuromyelitis Optica and Transverse Myelitits. Cerebral Palsy, brain injury or abnormality occurring within 24 hours of birth resulting in developmental brain disorder. Cystic Fibrosis, progressive disorder that affects exocrine glands. Muscular Dystrophy, progressive disorder that interferes with formation of healthy muscles. Poliomyelitis, acute, infectious disease caused by the poliovirus with indicated signs of the disease. Excludes non- paralytic polio or post-polio syndrome. Benign Brain Tumor, non-cancerous abnormal cells in the brain. Blindness, irreversible sight reduction in both eyes; Best corrected single eye visual acuity less than 20/200 (E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less. May require loss be due to specific illness. Coma, unconscious state lasting at least 96 continuous hours. Excludes any state of unconsciousness intentionally or medically induced from unconsciousness intentionally which the Covered Person is able to be aroused. May require loss be due to specific illness. End-Stage Renal (Kidney) Disease, chronic, irreversible function of both kidneys. Requires hemo or peritoneal dialysis. Major Organ Failure, includes: liver, lung, pancreas, kidney, heart or bone marrow. Happens when transplant is prescribed or recommended and placed on UNOS registry. If the Covered Person has a combination transplant (i.e. heart and lung), a single benefit amount will be payable. Recurrence Benefit not payable for same organ for which a benefit was previously paid. Paralysis, complete, permanent loss of use of two or more limbs due to a disease. Excludes loss due to Stroke and Multiple Sclerosis. May require loss be due to specific illness. No Evidence of Disease, for cancer means recommended treatment has been completed and a physician through a round of bloodwork or special imaging studies confirms there is no evidence of active primary malignant disease. For Heart Attack and Stroke means person discharged from the hospital. ***Benefits-Specific Conditions, Exclusions and Limitations (Additional Benefits): Hospital Indemnity: The Common Exclusions apply to this Additional Benefit. In addition, the following applies: Hospital Pandemic Infectious Disease Admission: Must be admitted inpatient due to a Pandemic Infectious Disease. Excludes: treatment in an emergency room, provided on an outpatient basis. Hospital Admission: Must be admitted inpatient due to injury or sickness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same injury or sickness. Hospital Chronic Condition Admission: Must be admitted inpatient due to a chronic condition. Excludes: treatment in an emergency room, provided on an
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