The Pre-Existing Condition Limitation does not apply Preventative Care benefits are not available
North Carolina residents:
1) Under the General Definitions section, the following changes are made: a) The second statement of the Active Service definition is replaced with the following: 2. a scheduled holiday or holiday period, vacation day or period of Employer-approved paid leave of absence, only if the Employee was in Active Service on the preceding scheduled workday. b) The Cancer definition includes the following: If Cancer is not pathologically or clinically diagnosed until after a Covered Person’s death, We shall assume liability retroactively beginning with the date of terminal admission to the hospital for not less than 45 days before the Covered Person’s date of death. In addition to the required pathological or clinical diagnosis, we may require additional information from the attending physician and hospital. c) The Dependent Child definition includes adopted child and foster child as follows: 2) adopted child, beginning with the date of the filing of the petition for adoption. It also means the legally adopted child of the Employee’s Spouse or domestic partner/Partner to a Civil Union provided the child is living with, and is financially dependent upon the Employee; 3) a foster child placed with you by an authorized placement agency or by judgment, decree or other order of any court of competent jurisdiction; 2) Under the General Definitions section, the first paragraph of the Hospital definition is replaced with the following: An institution or duly licensed State tax-supported institution that meets all of the following: 1. It is licensed as a Hospital pursuant to applicable law; 2. It is primarily and continuously engaged in providing medical care and treatment to sick and injured persons; 3. It is managed under the supervision of a staff of medical doctors; 4. It provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); 5. It has medical, diagnostic and treatment facilities, with major surgical facilities on its premises, or available to it on a prearranged basis. The requirement for major surgical facilities does not apply to a duly licensed State tax- supported institution. 3) Under the Individual Enrollment Events section, the following are included as reasons for a change under Life Status Change provision:
placement of a foster child into the named insured’s home; issuance of a court order requiring coverage of a child;
4) Under the Exclusions and Limitations section the war or act of war exclusion is replaced with the following: declared or undeclared war or act of war. This Exclusion does not apply to acts of terrorism; 5) Under the Claim Provisions section, the following changes are made: a) The Proof of Loss is replaced with the following: Proof of Loss Written or authorized electronic proof of loss satisfactory to Us must be given to Us at Our office, within 180 days of the loss for which claim is made. If (a) benefits are payable as periodic payments and (b) each payment is
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