Limited Accident and Sickness Fixed Indmenity Insurance Plan Exclusions
What's Not Covered?
SecureCare Limited Accident and Sickness Indemnity Insurance Plans underwritten by ACE American Insurance Co. will not pay for any loss, injury or sickness that is caused by, or results from:
- Intentionally self-inflicted injury.
- Suicide or attempted suicide.
- War or any act of war, whether declared or not.
- Service in the military, naval or air service of any country.
- Commission of, or attempt to commit, a felony, an assault or other illegal activity.
- Commission of or active participation in a riot, or insurrection.
- An accident if the covered person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's licenses, except while participating in a Driver's Education Program.
- Travel or activity outside the United States, except for a Medical Emergency.
- Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Doctor unless specifically provided herein.
- Repair or replacement of existing dentures, partial dentures, braces fixed or removable bridges, or other artificial dental restoration.
- Repair, replacement, examinations for prescriptions or the fitting of eyeglasses or contact lenses.
- While the covered person is legally intoxicated (as determined by that state's laws) or while under the influence of any drug unless administered under the advice and consent of a Physician.
- Injury to a covered person resulting from that covered person's willful violation of the Policyholder's rules or regulations. Willful violations includes, but is not limited to: a) working without protective clothing, helmets, gloves, etc. required by the Policyholder's rules or regulations; or b) participating in any activity that is in violation of the Policyholder's rules or regulations.
- Pre-Existing Conditions* occurring in the first six months of coverage (applies to Hospital & Surgery benefits only).
- Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.
- Mental and Nervous Disorders (except as provided in the Policy).
- Cosmetic surgery, except for reconstructive surgery needed as the result of an injury or sickness.
- Experimental or Investigational drugs, services, supplies or any procedure held to be experimental or investigatory by Us at the time the procedure is done.
- Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any relate procedures, including complications.
- Treatment or services provided by a private duty nurse.
- Treatment by a family member or member of the Covered Person's family.
- Routine dental care and treatment, except for treatment of Injury as specified in the Policy.
* A Pre-Existing Condition is an illness or disease or other condition, that in the 6 month period before the person's coverage is effective:
- first manifested itself, worsened, became acute or exhibited the symptoms that would have caused an ordinarily prudent person to seek diagnosis, care or treatment; or
- required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or
- was treated by a doctor or treatment had been recommended by a doctor.
This insurance does not apply to the extent that trade or economic sanctions prohibit ACE American Insurance Company from providing insurance, including but not limited to the payment of claims.