rendering care and treatment to a Covered Person that is appropriate for the condition and locality and who is not: 1. living in the Covered Person’s household; or 2. a parent, sibling, spouse or child of the Covered Person. However, this restriction of family members does not apply in those areas in which the family member is the only Physician in the area and is acting within His scope of practice.
2) Under the Exclusions and Limitations section, the list of exclusions is replaced with the following:
intentionally self-inflicted Injury, suicide or any attempt 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. diagnosis not in accordance with generally accepted medical principles prevailing in the United States at the time of the diagnosis. 3) Under the Exclusions and Limitations section, the following changes are made: a) The following exclusions are removed: 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; b) The Pre-Existing Condition Limitation is revised as follows: Pre-Existing Condition Limitation No benefit will be paid for a Covered Loss which is caused, contributed to by, or resulting from a Pre-existing Condition, except for Childhood Conditions listed in the Schedule of Benefits for a Dependent Child covered from birth during the first 12 months following the most recent effective date of the Covered Person’s coverage, and the effective date of any added or increased amount of coverage. The term “Pre-existing Condition” means any Sickness or Injury for which a Covered Person received medical treatment, advice, care or services including diagnostic measures, or took prescribed drugs or medicines within 6 months before the Covered Person’s most recent effective date of coverage, and the most recent effective date of any added or increased amount of coverage. The Pre-existing Condition Limitation will apply to any added benefits or increases in benefits.
Texas residents: 1) Under the General Definitions section, the following changes are made: a) The definition of Active Service is replaced with the following:
58
Made with FlippingBook. PDF to flipbook with ease