SLPC 25442 1/17 (exp. 1/19)
Critical Illness insurance
What exclusions apply to the benefits payable?*
In addition to the exclusions stated in the Covered Conditions section of this Certificate, we will not pay any benefit that is caused by, contributed to in any way, or resulting from any Critical Illness condition diagnosed outside the United States or Canada without confirmation of the Diagnosis by the type of Specialist Physician specified for each of the Covered Conditions in the certificate who practices in the United States or Canada.
We will not pay a benefit for any Critical Illness that is due to or results from:
- services or Treatment not included in the Benefit Highlights;
- services or Treatment provided by a Family Member;
- Treatment or complications of Treatment not related to a Critical Illness;
- an autologous bone marrow transplant, one in which your own bone marrow is used;
- intentionally self-inflicted injuries;
- elective plastic or cosmetic surgery;
- active military duty;
- war or any act of war or your active duty in any armed service during a time of war (this does not include acts of terrorism);
- your active Participation in a Riot, Rebellion or Insurrection;
- committing or attempting to commit an assault, felony or other criminal act;
- your engagement in dangerous conduct or hazardous activity where there is a likelihood of death or serious Injury;
- committing or attempting to commit suicide, whether sane or insane;
- incarceration in a penal institution of any kind; or
- being legally Intoxicated or under the influence of any narcotic unless taken on the advice of a Physician and taken as prescribed.
What limitations apply to the benefits payable?*
In addition to the limitations stated in the Covered Conditions section of this Certificate, we will not pay any benefit for any Critical Illness that is Diagnosed in the first exclusionary period following the effective date of any Insured’s insurance and results from a Pre-Existing Condition.
Pre-Existing Condition means during the exclusionary period prior to any Insured’s effective date of insurance or the effective date of an increase in any Insured’s amount of insurance, any condition for which any Insured:
- sought medical Treatment, consultation, advice, care or services, including diagnostic measures for the condition, or symptoms related to the condition, regardless of whether the condition was Diagnosed or suspected at that time; or
- took prescribed drugs or medicines for the condition.
When newborn children, newly placed foster children or newly adopted children are added to your Dependent Children Insurance within 31 days of the birth, placement or adoption, the Pre-Existing Condition limitation does not apply.
*Subject to state law variations.