SLPC 25442 8/14 (exp. 8/16)
The exclusions and limitations listed below may vary by state.
What exclusions apply to the benefits payable?
In addition to the exclusions stated in the Covered Conditions section of the 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: intentionally self inflicted injuries; elective plastic or cosmetic surgery; active military duty; participation in war, declared or undeclared, or any act of war; active participation in a riot, rebellion or insurrection; committing or attempting to commit an assault, felony or other criminal act; engagement in dangerous conduct or hazardous activity where there is a likelihood of death or serious injury; being legally intoxicated or under the influence of any narcotic unless taken on the advice of a physician and taken as prescribed; or improper or illegal use of inhalants or huffing.
Covered Conditions have specific diagnostic criteria that must be met (along with supporting documentation) for a benefit to be paid. For additional information regarding covered conditions, please request an outline of coverage.
What limitations apply to the benefits payable?
In addition to the limitations stated in the Covered Conditions section of the 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, regardless of whether the condition was diagnosed or suspected at that time;
- took prescribed drugs or medicines for the condition; or
- had symptoms for which an ordinarily prudent person would have consulted a health care provider for diagnosis, care or treatment.
When newborn children, newly placed foster children, or newly adopted children are added to Dependent Children Insurance within a certain number of days (as noted in the certificate) of birth, placement, or adoption, the Pre-Existing Condition limitation does not apply.