Must be admitted on an Inpatient basis.
Benefit Limitations #3 The word Initial was removed from Intensive Care Unit benefit
The definition of ICU is revised by removing the following sentence. The Covered Person must be admitted to a Hospital for at least 23 hours
2) Under the Common Exclusions section, the following changes are made:
a) The following exclusions do not apply:
• 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 including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. ''Under the influence of alcohol'', for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Accident occurred.
b) The following exclusion is amended, to not exclude treatment rendered by a family member:
•
services or treatment rendered by a Physician, Nurse or any other person who is: a. employed or retained by the Policyholder; b. providing homeopathic, aroma-therapeutic or herbal therapeutic services;
3) Under the Portability Provisions section, the following are removed from the Termination of Ported Insurance provisions:
• for a Dependent Child, the date the Dependent Child reaches age 26 unless primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap or ceases to quality as a Dependent Child; • the date the Spouse or Dependent no longer meets the definition of Spouse or Dependent Child; • the date the Covered Person is considered to reside outside the United States. The Covered Person will be considered to reside outside the United States when the Covered Person has been outside the United States for a total period of 4 months during any 4 consecutive months.
4) Under the Administrative Provisions section, The Changes in Premium Rates provision was changed from 31 days to 45 days for advance written notice.
Texas residents:
1) Portability is replaced with the Continuation of Loss of Eligibility and the Portability Provision does not apply. The following Continuation of Loss of Eligibility benefit periods have been added to the Schedule of Benefits section.
Loss of Eligibility
Maximum Benefit Period
Employee
to age 100 to age 100 to age 26
Spouse
Dependent Children
2) Under the Description of Coverages and Benefits Treatment section, the Emergency Care Benefit exclusion is replaced with the following:
Benefits will not be payable for treatment provided by an Immediate Family Member; this
Exclusions
exclusion does not apply to a licensed dentist.
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