No benefit will be paid for a Covered Injury or Covered Illness caused, contributed to by, or resulting from a Pre- existing Condition 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 Illness 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 insurance, and the most recent effective date of any added or increased amount of insurance.
The Pre-existing Condition Limitation will apply to any added benefits or increases in benefits.
b) The word “initial” is removed from Critical Illness Benefit and the benefit payment conditions.
c) 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 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 Injury or Covered Illness occurred.
Texas residents:
1) Benefits are not available for Skilled Nursing Facility.
2) Benefits are not available for any At-Home Care, Hospice Facility Care or Additional Inpatient and Outpatient Care Benefits except benefits will be available for Inpatient Surgery.
3) Under the Descriptions of Benefits section, if the Newborn Nursery Care Benefit(s) are included, the following Benefit Limitation is added to the Hospital Admission, Hospital Chronic Condition Admission, Hospital Stay and Hospital Intensive Care Unit (ICU) Stay benefits:
If a Covered Person is eligible for the Newborn Nursery Care Admission Benefit for the same Covered Injury or Covered Illness regardless of the date of service, this benefit will only be paid if it is the greater amount.
4) Under the General Definitions section, make the following changes:
a) Under the Age definition, item 3 is replaced with the following:
3.
For the purposes of Portability, except as to premium calculations, Extension of Benefits, Waiver of Premium Continuation due to Disability a Covered Person’s Age is His Age as of His last birthday.
b) Under the Complications of Pregnancy definition:
i) Item 2 is replaced with the following:
2. whose diagnosis is distinct from pregnancy but is or caused by pregnancy.
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