LIMITATIONS
Pre-existing Conditions: If an existing medical condition is disclosed on your application and not excluded or restricted by a rider, it is covered for a lifetime maximum of $50,000 ($5,000 per Policy Period), after you have been continuously insured for two consecutive and continuous policy periods. Otherwise, pre-existing conditions are not covered.
Pre-existing conditions are defined as any medical condition, sickness, injury, illness, disease, mental illness or mental nervous disorder, regardless of the cause, including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time prior to your effective date of coverage under this certificate, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed. This specifically includes but is not limited to any medical condition, sickness, injury, illness, disease, mental illness or mental nervous disorder for which medical advice, diagnosis, care or treatment was recommended or received, or for which a reasonably prudent person would have sought treatment prior to the effective date of coverage.
Exclusions*: The following conditions, treatments, supplies, services, and/or expenses are not covered.
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Treatment of the following which manifest themselves or are recommended, or in which symptoms occur during the first 180 days of coverage: any breast condition, any prostate condition, reproductive system disorders, gall stones, kidney stones, any acne diagnosis or acne-related condition, any surgery that is not emergency in nature.
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Pre-existing conditions as defined above.
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Expenses for pregnancy within the first 364 days of coverage.
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Claims not presented to us within 90 days of treatment.
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Treatment that is not medically necessary or exceeds reasonable & customary charges; treatment provided at no cost to you; non-medical expenses; treatment performed by a relative or anyone who lives with you; experimental treatment.
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Suicide or attempted suicide; self-inflicted injury or illness.
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War or warlike operations. • Injuries due to organized, professional, amateur, or interscholastic athletics.
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Temporomandibular joint. • Flat feet, fallen arches, corns, bunions, calluses, toenails.
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Vocational, occupational, speech, recreational or music therapy. • Cosmetic surgery unless due to a covered accident.
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Dental or eye treatment unless otherwise covered. • Injuries/illnesses due to alcohol, chemical, or drug use.
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Telephone consultations or failure to keep an appointment. • Custodial, rehabilitative, or nursing home care.
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Congenital conditions. • Expenses in connection with the commission or attempt of a criminal offense.
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Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, SCUBA diving (unless PADI, NAUI, YMCA, SSI or PDIC certified). (A Sports Rider may be purchased to cover certain activities.)
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Venereal or sexually transmitted disease, HIV, AIDS.
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Treatment, medication, & procedures to promote or prevent conception or childbirth.
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Chronic Fatigue Syndrome; occupational diseases; weight control. • Pregnancy expenses incurred by a dependent child.
*This is a review of the exclusions in the certificate. This is intended as a brief summary of benefits and services and is not your policy. A complete description of the provisions, benefits, and exclusions are contained in the certificate of coverage, which is provided to you after your coverage has been issued. To view a sample certificate of coverage, go to www.sevencorners.com/reside-prime/. If there is any difference between this brochure and your certificate of coverage, the provisions of the certificate will prevail.